Europe PMC

This website requires cookies, and the limited processing of your personal data in order to function. By using the site you are agreeing to this as outlined in our privacy notice and cookie policy.

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

Collaborators (141)

Author information

Affiliations

  • 1. Washington University School of Medicine, 660 S Euclid Ave, St Louis, MO 63110, USA.
      Authors
    • Kollef MH 1
    (1 author)

JAMA, 01 Aug 2008, 300(7):805-813
https://doi.org/10.1001/jama.300.7.805 PMID: 18714060 

A comment on this article appears in "Silver-coated endotracheal tubes and patient outcomes in ventilator-associated pneumonia." JAMA. 2008 Dec 10;300(22):2605; author reply 2605-6. A comment on this article appears in "Preventing ventilator-associated pneumonia: could silver-coated endotracheal tubes be the answer?" JAMA. 2008 Aug 20;300(7):842-4.

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 (> or = 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 10(4) 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.

Full text links 

Read article at publisher's site: https://doi.org/10.1001/jama.300.7.805

Free to read at jama.ama-assn.org
http://jama.ama-assn.org/cgi/content/abstract/300/7/805

Subscription required at jama.ama-assn.org
http://jama.ama-assn.org/cgi/content/full/300/7/805

Citations & impact 

Impact metrics

225
Citations
Jump to Citations

Citations of article over time

Alternative metrics

Altmetric item for https://www.altmetric.com/details/530656
Altmetric
Discover the attention surrounding your research
https://www.altmetric.com/details/530656

Smart citations by scite.ai
Smart citations by scite.ai include citation statements extracted from the full text of the citing article. The number of the statements may be higher than the number of citations provided by EuropePMC if one paper cites another multiple times or lower if scite has not yet processed some of the citing articles.
Explore citation contexts and check if this article has been supported or disputed.
https://scite.ai/reports/10.1001/jama.300.7.805

Supporting
Mentioning
Contrasting
2
259
0

Article citations

Go to all (225) article citations

Data 

Data behind the article

This data has been text mined from the article, or deposited into data resources.

Clinical Trials

Similar Articles 

To arrive at the top five similar articles we use a word-weighted algorithm to compare words from the Title and Abstract of each citation.