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| |  Silver-Coated Endotracheal Tubes Reduce Risk of Ventilator-Associated Pneumonia CHICAGO -- August 20, 2008 -- Among intensive care unit patients who require mechanical ventilation, use of a silver-coated endotracheal tube resulted in reduced incidence of pneumonia associated with ventilators, according to a study in the August 20 issue of the Journal of the American Medical Association. "Prevention strategies often focus on modifiable risk factors for colonisation and aspiration and can successfully reduce ventilator-associated pneumonia rates, but no single strategy completely eliminates ventilator-associated pneumonia," the authors wrote. Marin H. Kollef, MD, Washington University School of Medicine, St. Louis, Missouri, and colleagues in the NASCENT Investigation Group did a randomised controlled trial involving 2,003 patients at 54 centres who were expected to require mechanical ventilation for 24 hours or longer. Between 2002 and 2006, patients were randomly assigned to undergo intubation with either a silver-coated tube or a similar tube that was not coated. Of 1,509 patients who were intubated for 24 hours or longer, 4.8% of those with silver-coated tubes developed ventilator-associated pneumonia, compared with 7.5% of those with uncoated tubes -- a 35.9% relative reduction in risk. Among 1,932 patients who were on ventilators for any length of time, the silver coating was associated with a 34.2% relative reduction in risk of developing pneumonia (3.8% silver-coated tubes vs 5.8% uncoated tubes). In addition, the silver-coated tubes were associated with a delayed occurrence of ventilator-associated pneumonia. No differences were seen between both groups in median duration of intubation, length of stay in the intensive care unit or in the hospital, death rates or frequency, and severity of adverse events. "… The silver-coated endotracheal tube significantly reduced the incidence of microbiologically confirmed, ventilator-associated pneumonia and had its greatest benefit during the peak time of ventilator-associated pneumonia occurrence, without any notable adverse events," said the authors. "The silver-coated endotracheal tube appears to offer a unique approach because it is the first intervention that becomes user-dependent after intubation, requiring no further action by the clinician." In an accompanying editorial, Jean Chastre, MD, Groupe Hospitalier Pitie-Salpetriere, Paris, France, said that clinicians should reconsider using silver-coated endotracheal tube for "patients at very high risk of developing early-onset, ventilator-associated pneumonia, such as neurologically impaired patients or trauma patients, because the greatest effect of the intervention appeared to occur during the first 10 days of mechanical ventilation and was clinically relevant, with minimal effect on clinician workload." However, Dr. Chastre also noted that silver-coated tubes "should not be viewed as the definitive answer for ventilator-associated pneumonia prevention, and, until additional data confirm the clinical effectiveness and cost benefit of these devices, their issue should be restricted to high-risk patients treated in ICUs."
SOURCE: American Medical Association
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