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Editorials |

Fighting Vampires and Ventilator-Associated Pneumonia: Is Silver the Magic Bullet?

Michael S. Niederman, MD, FCCP
Author and Funding Information

Department of Medicine, Winthrop-University Hospital, Mineola, NY; and Department of Medicine, SUNY at Stony Brook, NY.

Correspondence to: Michael S. Niederman, MD, FCCP, 222 Station Plaza N, Ste 509, Mineola, NY 11501; e-mail: mniederman@winthrop.org


Financial/nonfinancial disclosures: The author has reported to CHEST the following conflicts of interest: Dr Niederman has served as a consultant to Aerogen, Bayer, Ceragenix, Merck, Johnson and Johnson, Schering, and Pfizer. He has received grant support from Aerogen and lecture fees from Pfizer, Bayer, Johnson and Johnson, Schering, and Merck.

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


© 2010 American College of Chest Physicians


Chest. 2010;137(5):1007-1009. doi:10.1378/chest.10-0063
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Silver is considered to be a metal of purity, being used for protection against evil in almost every world culture throughout history, and its ability to kill vampires and werewolves is legendary. In medicine, the antibacterial and biofilm-inhibiting properties of silver have led to its incorporation into prosthetic, invasive devices, such as central venous catheters and endotracheal tubes. A silver-coated endotracheal tube is currently available (Agento tube by C. R. Bard, Inc.; Covington, GA) and is constructed with silver ions, which are microdispersed in the tube polymer on both the inner and outer surfaces. Ions can migrate to the surface, acting in an antibacterial fashion, blocking bacterial binding to the tube and biofilm formation. In one small randomized trial, a silver-coated tube reduced the burden of bacterial colonization in intubated patients.1 This was followed by a large clinical trial, the North American Silver-Coated Endotracheal Tube (NASCENT) Study, which demonstrated that the use of this tube in patients ventilated for > 24 hours led to a 35.9% relative risk reduction, and an absolute risk reduction of 2.7%, in the frequency of quantitative culture-confirmed ventilator-associated pneumonia (VAP).2 In this unblinded trial, 37 patients needed to be treated to prevent one episode of VAP, but there was no impact on ICU mortality, duration of mechanical ventilation, and ICU length of stay; the investigators did not report the impact of the new tube on the use of antibiotics during the study period.3

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