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Correspondence |

Increased Mortality in Patients Without Ventilator-Associated Pneumonia FREE TO VIEW

Steven Deem, MD
Author and Funding Information

Department of Anesthesiology, Critical Care Medicine, Harborview Medical Center.

Correspondence to: Steven Deem, MD, Anesthesiology, Harborview Medical Center, Box 359724, 325 Ninth Ave, Seattle WA 98104-2499; e-mail: sdeem@u.washington.edu


Financial/nonfinancial disclosures: The author has reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be dis­cussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2010 American College of Chest Physicians


Chest. 2010;138(5):1274-1275. doi:10.1378/chest.10-1153
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Published online

To the Editor:

In regard to the recently published article in CHEST by Afessa et al (May 2010),1 the association between silver-coated tracheal tubes and reduced mortality in patients who developed ventilator-associated pneumonia (VAP) was interesting. However, more intriguing and much more concerning was the observation that silver-coated tubes were associated with increased mortality in patients without VAP. This is particularly relevant given that in most institutions, the number of patients who do not develop VAP vastly outnumber those who do, implying that silver-coated tubes may result in an overall excess in deaths. This concern is borne out in the original North American Silver-Coated Endotracheal Tube (NASCENT) trial,2 in which mortality was higher in the group randomized to receive silver-coated endotracheal tubes (30.9% vs 27.3%, P = .08). Although this difference did not reach statistical significance, the strong trend raises significant concerns about the safety and overall benefits of the silver-coated endotracheal tube. Extrapolating the mortality figures published by Afessa et al1 to Harborview Medical Center in Seattle, Washington, it is estimated that routine use of the silver-coated endotracheal tube in our institution would result in an excess of 54 deaths per year. It would be helpful if the authors could comment on this concern and on the potential mechanism for increased mortality related to the silver-coated endotracheal tube.

Afessa B, Shorr AF, Anzueto AR, Craven DE, Schinner R, Kollef MH. Association between a silver-coated endotracheal tube and reduced mortality in patients with ventilator-associated pneumonia. Chest. 2010;1375:1015-1021. [CrossRef] [PubMed]
 
Kollef MH, Afessa B, Anzueto A, et al; NASCENT Investigation Group NASCENT Investigation Group Silver-coated endotracheal tubes and incidence of ventilator-associated pneumonia: the NASCENT randomized trial. JAMA. 2008;3007:805-813. [CrossRef] [PubMed]
 

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References

Afessa B, Shorr AF, Anzueto AR, Craven DE, Schinner R, Kollef MH. Association between a silver-coated endotracheal tube and reduced mortality in patients with ventilator-associated pneumonia. Chest. 2010;1375:1015-1021. [CrossRef] [PubMed]
 
Kollef MH, Afessa B, Anzueto A, et al; NASCENT Investigation Group NASCENT Investigation Group Silver-coated endotracheal tubes and incidence of ventilator-associated pneumonia: the NASCENT randomized trial. JAMA. 2008;3007:805-813. [CrossRef] [PubMed]
 
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