Silver-coated endotracheal tubes and incidence of ventilator-associated pneumonia: The NASCENT randomized trial

Marin H. Kollef, Bekele Afessa, Antonio R Anzueto, Christopher Veremakis, Kim M. Kerr, Benjamin D. Margolis, Donald E. Craven, Pamela R. Roberts, Alejandro C. Arroliga, Rolf D. Hubmayr, Marcos Restrepo, William R. Auger, Regina Schinner

Research output: Contribution to journalArticle

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Abstract

Context: Ventilator-associated pneumonia (VAP) causes substantial morbidity. A silver-coated endotracheal tube has been designed to reduce VAP incidence by preventing bacterial colonization and biofilm formation. Objective: To determine whether a silver-coated endotracheal tube would reduce the incidence of microbiologically confirmed VAP. Design, Setting, and Participants: Prospective, randomized, single-blind, controlled study conducted in 54 centers in North America. A total of 9417 adult patients (≥18 years) were screened between 2002 and 2006. A total of 2003 patients expected to require mechanical ventilation for 24 hours or longer were randomized. Intervention: Patients were assigned to undergo intubation with 1 of 2 high-volume, low-pressure endotracheal tubes, similar except for a silver coating on the experimental tube. Main Outcome Measures: Primary outcome was VAP incidence based on quantitative bronchoalveolar lavage fluid culture with 104 colony-forming units/mL or greater in patients intubated for 24 hours or longer. Other outcomes were VAP incidence in all intubated patients, time to VAP onset, length of intubation and duration of intensive care unit and hospital stay, mortality, and adverse events. Results: Among patients intubated for 24 hours or longer, rates of microbiologically confirmed VAP were 4.8% (37/766 patients; 95% confidence interval [CI], 3.4%-6.6%) in the group receiving the silver-coated tube and 7.5% (56/743; 95% CI, 5.7%-9.7%) (P=.03) in the group receiving the uncoated tube (all intubated patients, 3.8% [37/968; 95% CI, 2.7%-5.2%] and 5.8% [56/964; 95% CI, 4.4%-7.5%] [P=.04]), with a relative risk reduction of 35.9% (95% CI, 3.6%-69.0%; all intubated patients, 34.2% [95% CI, 1.2%-67.9%]). The silver-coated endotracheal tube was associated with delayed occurrence of VAP (P=.005). No statistically significant between-group differences were observed in durations of intubation, intensive care unit stay, and hospital stay; mortality; and frequency and severity of adverse events. Conclusion: Patients receiving a silver-coated endotracheal tube had a statistically significant reduction in the incidence of VAP and delayed time to VAP occurrence compared with those receiving a similar, uncoated tube. Trial Registration: clinicaltrials.gov Identifier: NCT00148642.

Original languageEnglish (US)
Pages (from-to)805-813
Number of pages9
JournalJAMA - Journal of the American Medical Association
Volume300
Issue number7
DOIs
StatePublished - Aug 20 2008

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Ventilator-Associated Pneumonia
Silver
Incidence
Confidence Intervals
Intubation
Intensive Care Units
Length of Stay
Single-Blind Method
Bronchoalveolar Lavage Fluid
Risk Reduction Behavior
Biofilms
North America
Hospital Mortality
Artificial Respiration
Stem Cells
Outcome Assessment (Health Care)
Morbidity
Pressure

ASJC Scopus subject areas

  • Medicine(all)

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Silver-coated endotracheal tubes and incidence of ventilator-associated pneumonia : The NASCENT randomized trial. / Kollef, Marin H.; Afessa, Bekele; Anzueto, Antonio R; Veremakis, Christopher; Kerr, Kim M.; Margolis, Benjamin D.; Craven, Donald E.; Roberts, Pamela R.; Arroliga, Alejandro C.; Hubmayr, Rolf D.; Restrepo, Marcos; Auger, William R.; Schinner, Regina.

In: JAMA - Journal of the American Medical Association, Vol. 300, No. 7, 20.08.2008, p. 805-813.

Research output: Contribution to journalArticle

Kollef, MH, Afessa, B, Anzueto, AR, Veremakis, C, Kerr, KM, Margolis, BD, Craven, DE, Roberts, PR, Arroliga, AC, Hubmayr, RD, Restrepo, M, Auger, WR & Schinner, R 2008, 'Silver-coated endotracheal tubes and incidence of ventilator-associated pneumonia: The NASCENT randomized trial', JAMA - Journal of the American Medical Association, vol. 300, no. 7, pp. 805-813. https://doi.org/10.1001/jama.300.7.805
Kollef, Marin H. ; Afessa, Bekele ; Anzueto, Antonio R ; Veremakis, Christopher ; Kerr, Kim M. ; Margolis, Benjamin D. ; Craven, Donald E. ; Roberts, Pamela R. ; Arroliga, Alejandro C. ; Hubmayr, Rolf D. ; Restrepo, Marcos ; Auger, William R. ; Schinner, Regina. / Silver-coated endotracheal tubes and incidence of ventilator-associated pneumonia : The NASCENT randomized trial. In: JAMA - Journal of the American Medical Association. 2008 ; Vol. 300, No. 7. pp. 805-813.
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abstract = "Context: Ventilator-associated pneumonia (VAP) causes substantial morbidity. A silver-coated endotracheal tube has been designed to reduce VAP incidence by preventing bacterial colonization and biofilm formation. Objective: To determine whether a silver-coated endotracheal tube would reduce the incidence of microbiologically confirmed VAP. Design, Setting, and Participants: Prospective, randomized, single-blind, controlled study conducted in 54 centers in North America. A total of 9417 adult patients (≥18 years) were screened between 2002 and 2006. A total of 2003 patients expected to require mechanical ventilation for 24 hours or longer were randomized. Intervention: Patients were assigned to undergo intubation with 1 of 2 high-volume, low-pressure endotracheal tubes, similar except for a silver coating on the experimental tube. Main Outcome Measures: Primary outcome was VAP incidence based on quantitative bronchoalveolar lavage fluid culture with 104 colony-forming units/mL or greater in patients intubated for 24 hours or longer. Other outcomes were VAP incidence in all intubated patients, time to VAP onset, length of intubation and duration of intensive care unit and hospital stay, mortality, and adverse events. Results: Among patients intubated for 24 hours or longer, rates of microbiologically confirmed VAP were 4.8{\%} (37/766 patients; 95{\%} confidence interval [CI], 3.4{\%}-6.6{\%}) in the group receiving the silver-coated tube and 7.5{\%} (56/743; 95{\%} CI, 5.7{\%}-9.7{\%}) (P=.03) in the group receiving the uncoated tube (all intubated patients, 3.8{\%} [37/968; 95{\%} CI, 2.7{\%}-5.2{\%}] and 5.8{\%} [56/964; 95{\%} CI, 4.4{\%}-7.5{\%}] [P=.04]), with a relative risk reduction of 35.9{\%} (95{\%} CI, 3.6{\%}-69.0{\%}; all intubated patients, 34.2{\%} [95{\%} CI, 1.2{\%}-67.9{\%}]). The silver-coated endotracheal tube was associated with delayed occurrence of VAP (P=.005). No statistically significant between-group differences were observed in durations of intubation, intensive care unit stay, and hospital stay; mortality; and frequency and severity of adverse events. Conclusion: Patients receiving a silver-coated endotracheal tube had a statistically significant reduction in the incidence of VAP and delayed time to VAP occurrence compared with those receiving a similar, uncoated tube. Trial Registration: clinicaltrials.gov Identifier: NCT00148642.",
author = "Kollef, {Marin H.} and Bekele Afessa and Anzueto, {Antonio R} and Christopher Veremakis and Kerr, {Kim M.} and Margolis, {Benjamin D.} and Craven, {Donald E.} and Roberts, {Pamela R.} and Arroliga, {Alejandro C.} and Hubmayr, {Rolf D.} and Marcos Restrepo and Auger, {William R.} and Regina Schinner",
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T1 - Silver-coated endotracheal tubes and incidence of ventilator-associated pneumonia

T2 - The NASCENT randomized trial

AU - Kollef, Marin H.

AU - Afessa, Bekele

AU - Anzueto, Antonio R

AU - Veremakis, Christopher

AU - Kerr, Kim M.

AU - Margolis, Benjamin D.

AU - Craven, Donald E.

AU - Roberts, Pamela R.

AU - Arroliga, Alejandro C.

AU - Hubmayr, Rolf D.

AU - Restrepo, Marcos

AU - Auger, William R.

AU - Schinner, Regina

PY - 2008/8/20

Y1 - 2008/8/20

N2 - Context: Ventilator-associated pneumonia (VAP) causes substantial morbidity. A silver-coated endotracheal tube has been designed to reduce VAP incidence by preventing bacterial colonization and biofilm formation. Objective: To determine whether a silver-coated endotracheal tube would reduce the incidence of microbiologically confirmed VAP. Design, Setting, and Participants: Prospective, randomized, single-blind, controlled study conducted in 54 centers in North America. A total of 9417 adult patients (≥18 years) were screened between 2002 and 2006. A total of 2003 patients expected to require mechanical ventilation for 24 hours or longer were randomized. Intervention: Patients were assigned to undergo intubation with 1 of 2 high-volume, low-pressure endotracheal tubes, similar except for a silver coating on the experimental tube. Main Outcome Measures: Primary outcome was VAP incidence based on quantitative bronchoalveolar lavage fluid culture with 104 colony-forming units/mL or greater in patients intubated for 24 hours or longer. Other outcomes were VAP incidence in all intubated patients, time to VAP onset, length of intubation and duration of intensive care unit and hospital stay, mortality, and adverse events. Results: Among patients intubated for 24 hours or longer, rates of microbiologically confirmed VAP were 4.8% (37/766 patients; 95% confidence interval [CI], 3.4%-6.6%) in the group receiving the silver-coated tube and 7.5% (56/743; 95% CI, 5.7%-9.7%) (P=.03) in the group receiving the uncoated tube (all intubated patients, 3.8% [37/968; 95% CI, 2.7%-5.2%] and 5.8% [56/964; 95% CI, 4.4%-7.5%] [P=.04]), with a relative risk reduction of 35.9% (95% CI, 3.6%-69.0%; all intubated patients, 34.2% [95% CI, 1.2%-67.9%]). The silver-coated endotracheal tube was associated with delayed occurrence of VAP (P=.005). No statistically significant between-group differences were observed in durations of intubation, intensive care unit stay, and hospital stay; mortality; and frequency and severity of adverse events. Conclusion: Patients receiving a silver-coated endotracheal tube had a statistically significant reduction in the incidence of VAP and delayed time to VAP occurrence compared with those receiving a similar, uncoated tube. Trial Registration: clinicaltrials.gov Identifier: NCT00148642.

AB - Context: Ventilator-associated pneumonia (VAP) causes substantial morbidity. A silver-coated endotracheal tube has been designed to reduce VAP incidence by preventing bacterial colonization and biofilm formation. Objective: To determine whether a silver-coated endotracheal tube would reduce the incidence of microbiologically confirmed VAP. Design, Setting, and Participants: Prospective, randomized, single-blind, controlled study conducted in 54 centers in North America. A total of 9417 adult patients (≥18 years) were screened between 2002 and 2006. A total of 2003 patients expected to require mechanical ventilation for 24 hours or longer were randomized. Intervention: Patients were assigned to undergo intubation with 1 of 2 high-volume, low-pressure endotracheal tubes, similar except for a silver coating on the experimental tube. Main Outcome Measures: Primary outcome was VAP incidence based on quantitative bronchoalveolar lavage fluid culture with 104 colony-forming units/mL or greater in patients intubated for 24 hours or longer. Other outcomes were VAP incidence in all intubated patients, time to VAP onset, length of intubation and duration of intensive care unit and hospital stay, mortality, and adverse events. Results: Among patients intubated for 24 hours or longer, rates of microbiologically confirmed VAP were 4.8% (37/766 patients; 95% confidence interval [CI], 3.4%-6.6%) in the group receiving the silver-coated tube and 7.5% (56/743; 95% CI, 5.7%-9.7%) (P=.03) in the group receiving the uncoated tube (all intubated patients, 3.8% [37/968; 95% CI, 2.7%-5.2%] and 5.8% [56/964; 95% CI, 4.4%-7.5%] [P=.04]), with a relative risk reduction of 35.9% (95% CI, 3.6%-69.0%; all intubated patients, 34.2% [95% CI, 1.2%-67.9%]). The silver-coated endotracheal tube was associated with delayed occurrence of VAP (P=.005). No statistically significant between-group differences were observed in durations of intubation, intensive care unit stay, and hospital stay; mortality; and frequency and severity of adverse events. Conclusion: Patients receiving a silver-coated endotracheal tube had a statistically significant reduction in the incidence of VAP and delayed time to VAP occurrence compared with those receiving a similar, uncoated tube. Trial Registration: clinicaltrials.gov Identifier: NCT00148642.

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