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Original Research: CRITICAL CARE MEDICINE |

Association Between a Silver-Coated Endotracheal Tube and Reduced Mortality in Patients With Ventilator-Associated Pneumonia

Bekele Afessa, MD, FCCP; Andrew F. Shorr, MD, MPH, FCCP; Antonio R. Anzueto, MD; Donald E. Craven, MD; Regina Schinner, Dipl-Stat; Marin H. Kollef, MD, FCCP
Author and Funding Information

From the Division of Pulmonary and Critical Care Medicine (Dr Afessa), Mayo Clinic College of Medicine, Rochester, MN; Washington Hospital Center (Dr Shorr), Washington, DC; South Texas Veterans Health Care System, Audie L. Murphy Division (Dr Anzueto), San Antonio, TX; University Hospital and University of Texas Health Science Center at San Antonio (Dr Anzueto), San Antonio, TX; Lahey Clinic Medical Center (Dr Craven), Burlington, MA; Tufts University School of Medicine (Dr Craven), Boston, MA; FGK Clinical Research GmbH (Ms Schinner), Munich, Germany; and Washington University School of Medicine (Dr Kollef), St. Louis, MO.

Correspondence to: Bekele Afessa, MD, FCCP, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, 200 1st St SW, Rochester, MN 55905-0001; e-mail: Afessa.bekele@mayo.edu


This study was presented as a poster at the 2009 ATS International Conference and the abstract was published (Kollef MH, Afessa B, Anzueto A, et al. Reduced mortality in patients intubated with a silver-coated endotracheal tube in those who developed ventilator-associated pneumonia in the NASCENT Randomized Study. Am J Respir Crit Care Med. 2009;179:A5471).

Funding/Support: This study, including statistical analysis and manuscript preparation, was supported by a grant from C. R. Bard, Inc.

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

For editorial comment see page 1007


© 2010 American College of Chest Physicians


Chest. 2010;137(5):1015-1021. doi:10.1378/chest.09-0391
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Background:  A silver-coated endotracheal tube (ETT) reduced the incidence of ventilator-associated pneumonia (VAP) compared with an uncoated ETT in the North American Silver-Coated Endotracheal Tube (NASCENT) study.

Methods:  To evaluate the effect of an ETT and risk factors on mortality, we performed a retrospective cohort analysis in patients who developed VAP in the NASCENT study. We determined causes of death and VAP due to potentially multidrug-resistant bacteria (eg, Pseudomonas, Acinetobacter) and performed stepwise multivariate logistic regression with the following predefined variables: treatment group, Acute Physiology and Chronic Health Evaluation (APACHE) II score, continuous sedation, coma, COPD, emergency surgery/trauma, immunodeficiency, potentially multidrug-resistant bacteria, and inappropriate initial antibiotics.

Results:  The silver-coated ETT was associated with reduced mortality in patients with VAP (silver vs control, 5/37 [14%] vs 20/56 [36%], P = .03), but not in those without VAP (228/729 [31%] vs 178/687 [26%], P = .03). The only between-group difference in leading causes of death was respiratory failure (silver vs control, 45/233 [19%] vs 22/198 [11%], P = .02). Of the VAP-related deaths, one in the silver group was caused by Acinetobacter sepsis. In the control group, six deaths were caused by sepsis and three by pneumonia; six of nine pathogens were potentially multidrug resistant. In multivariate analysis, the treatment group was a predictor of mortality (odds ratio, silver vs control, 0.28; 95% CI, 0.09-0.89; P = .03). APACHE II ≥ 20 and inappropriate antibiotics also remained in the model (P < .1).

Conclusions:  These findings suggest that a silver-coated ETT was associated with reduced mortality in patients who developed VAP in the NASCENT study. Studies are needed to confirm these exploratory findings.

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