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Association Between a Silver-Coated Endotracheal Tube and Reduced Mortality in Patients With Ventilator-Associated Pneumonia.
Chest. 2009 Dec 28;
Authors: Afessa B, Shorr AF, Anzueto AR, Craven DE, Schinner R, Kollef MH
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 effect of 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, APACHE II, 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=0.03), but not in those without VAP (228/729 [31%] vs 178/687 [26%]; p=0.03). The only between-group difference in leading causes of death was respiratory failure (silver vs control, 45/233 [19%] vs 22/198 [11%]; p=0.02). Of the VAP-related deaths, 1 in the silver group was caused by Acinetobacter sepsis. In the control group, 6 deaths were caused by sepsis and 3 by pneumonia; 6 of 9 pathogens were potentially multidrug-resistant. In multivariate analysis, treatment group was a predictor of mortality (odds ratio, silver vs control, 0.28; 95% confidence interval, 0.09-0.89; p=0.03). APACHE II >/=20 and inappropriate antibiotics also remained in the model (p<0.1). CONCLUSIONS: These findings suggest that 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.
PMID: 20038737 [PubMed - as supplied by publisher]