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Silver-Coated Endotracheal Tube Cuts Pneumonia Incidence: Presented at CHEST By John Gever CHICAGO, IL -- October 25, 2007 -- Incidence of ventilator-associated pneumonia (VAP) was reduced by 36% when a silver-coated endotracheal tube was used in a study presented here at CHEST 2007, the annual meeting of the American College of Chest Physicians. The randomised, controlled, phase 3 trial was conducted at 54 clinical sites in North America and involved more than 1,500 patients receiving mechanical ventilation. At enrolment, study subjects were at least 18 years old and were expected to remain intubated for 1 day or longer. Bronchoalveolar lavage was performed in clinically suspected VAP cases. More than 2,000 patients were enrolled, but some 500 were intubated for less than a full day or not at all and were excluded from the analysis. The incidence of culture-confirmed VAP occurred in 4.8% of study patients who were assigned to intubation with the silver-coated tube versus 7.5% of patients assigned to intubation with a conventional tube (P =.032), reported Bekele Afessa, MD, Associate Professor of Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, United States. However, the silver-coated tube failed to decrease mortality significantly, said Dr. Afessa in an oral presentation October 24. Microscopy studies of the tubes themselves, after removal from patients, showed mostly dead bacteria attached to the silver-coated tubes, Dr. Afessa said, whereas large numbers of live bacteria and biofilms were seen on the conventional tubes. Dr. Afessa said his group wondered why the decline in VAP incidence with the silver-coated tube was not accompanied by reduced mortality. Consequently, using the data, they compared patients who did not develop VAP with those who did. No difference in mortality rate was seen between those who developed VAP and those who did not (26.9% versus 28.7%), Dr. Afessa said. But among those who developed VAP, median length of intensive care unit (ICU) stay was more than doubled (18 days versus 7 days, P <.0001), and the length of hospital stay was nearly double (27 days versus 15 days, P <.0001). However, the data could not shed light on the causal direction, he said. "Does prolonged ICU length of stay lead to VAP, or does VAP lead to prolonged length of stay? These are questions we cannot answer [with] this study." Previous research has reached differing conclusions on how VAP affects ICU outcomes, in part due to varying methodologies for attributing deaths to VAP, Dr. Afessa noted. The study was sponsored by C.R. Bard Inc., manufacturer of the silver-coated tube. [Presentation title: Morbidity of Ventilator-Associated Pneumonia in a Randomized Study of a Silver-Coated Endotracheal Tube. 935] E-mail this page to a friend or colleague! To print, use this version