Efficacy of Noble Metal–alloy Endotracheal Tubes in Ventilator-associated Pneumonia Prevention: a Randomized Clinical Trial

Abstract

Background: Endotracheal tube (ETT) is an important risk factor for the development of Ventilator-associated pneumonia (VAP), as it acts as a reservoir for infectious microorganisms and bypasses the host’s defenses. One of the preventive measures for VAP is endotracheal tube composition. It has been reported that biofilm formation is reduced by using ETTs coated with pure silver or silver compounds. However, noble metal-alloy ETTs have not been adequately studied. Aims: To evaluate the efficacy of noble metal alloy ETT (coated Bactiguard Infection Protection ETTs) in preventing VAP compared to standard non-coated ETTs in patients requiring ≥ 48 hours of mechanical ventilation and presenting for coma due to drug intoxication. Study Design: Randomized controlled study. Methods: Participants were randomized using sealed envelopes with a concealed 1:1 allocation to either the intervention group or the control group. The intervention group used a noble metal–alloy ETT, while the control group received standard ETT. The primary outcomes were the incidence of VAP (per ventilated patients) and the duration of mechanical ventilation. Results: Initially, a total of 188 patients were assessed for eligibility, and the final allocation group consisted of 180 patients, who were subsequently randomized into the intervention group (n = 97) and control group (n = 83). The incidence of VAP in the intervention and control groups was 27.83% and 43.16% ( P = 0.03), and the VAP ratio per 1000 ventilation days was 51.26/1000 and 83.38/1000 ( P = 0.01), respectively. The mean durations of mechanical ventilation were 3.2 ± 0.78 in the intervention group and 5.03 ± 1.88 in the control group ( P = 0.22). There was no statistically significant difference between groups in terms of mortality and duration of hospital stay. Conclusion: Noble metal-alloy ETT reduces the incidence of VAP, ventilation days, and ICU stay for patients in mechanical ventilation.

Antimicrobial Solutions for Endotracheal Tubes in Prevention of Ventilator-Associated Pneumonia

“…The clinical trial concluded that NMA-coated ETTs are a good candidate for FDA approval. Tincu et al [ 90 ] made a randomized controlled trial on 180 patients in a coma state induced by drug abuse who needed MV for a period longer than 48 h. The number of patients was divided into a control group receiving standard ETTs and another group using NMA-ETTs. They found that VAP incidence was 43.16% for the control group and 27.83% for the NMA-coated group.…”

The Current Knowledge on the Pathogenesis of Tissue and Medical Device-Related Biofilm Infections

“…As ETTs are difficult to remove when VAP appears, preventive measures are required to reduce biofilm formation. A recent randomized controlled trial demonstrated that noble metal alloy ETTs reduce the incidence of VAP, ventilation days, and ICU stays for patients in mechanical ventilation [ 75 ]. Although it must be assessed in a clinical setting, the application of a selective digestive decontamination solution used as “lock therapy” in the subglottic space seems to be a promising prophylactic approach that could be used in combination with the oro-digestive decontamination procedure in the prevention of VAP [ 76 ].…”