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Preventive Strategies in VAP: Focus on Silver-Coated Endotracheal Tubes

Chapter

Abstract

Introduction: Ventilator-associated pneumonia (VAP) is problematic because of its frequency, morbidity, and mortality. Many strategies have been studied in an attempt to reduce the rate of VAP. This chapter provides a comprehensive review of silver-coated endotracheal tubes in the prevention of VAP.

Methods: Two silver-coated endotracheal tubes have been studied in comparison with similar, uncoated tubes—each beginning with preclinical models and progressing to clinical studies. One is commercially available (Agento® IC, C. R. Bard, Covington, Georgia, United States) and is coated with silver ions micro-dispersed in a proprietary hydrophilic polymer. The other remains investigational and is prepared by submerging a standard endotracheal tube into silver sulfadiazine (with or without chlorhexidine) and polyurethane.

Results: Both silver-coated tubes were active in preclinical models designed to mimic surrogate endpoints for VAP, such as in vitro bacterial adherence, biofilm formation, and bacterial burden in animal models. Both tubes were active in phase 2 studies of patients requiring mechanical ventilation. The commercially available tube was active in a randomized, phase 3 study and reduced the incidence of microbiologically confirmed VAP at any time after intubation (silver vs. uncoated, 37/766 [4.8 %] vs. 56/743 [7.5 %]; P = 0.03; relative risk reduction, 35.9 %) and within 10 days of intubation (27/766 [3.5 %] vs. 50/743 [6.7 %]; P = 0.005, relative risk reduction, 47.6 %).

Conclusions: The silver-coated endotracheal tube is a promising strategy for preventing VAP. The commercially available tube meets the standards for evidence-based guidelines because effectiveness is supported by the results of a well-designed, phase 3 study. In addition, the device is suitable for use in the intensive care unit because it becomes user independent after intubation and does not add to the burden of busy healthcare providers.

Keywords

Intensive Care Unit Endotracheal Tube Relative Risk Reduction Silver Coating Bacterial Burden 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Abbreviations

AMMI Canada

Association of Medical Microbiology and Infectious Disease Canada

ATS/IDSA

American Thoracic Society/Infectious Diseases Society of America

BSAC

British Society for Antimicrobial Chemotherapy

CCCTG

Canadian Critical Care Trials Group

CPIS

Clinical pulmonary infection score

GPP

Good practice point

HAP

Healthcare-associated pneumonia

ICU

Intensive care unit

IHI

Institute for Healthcare Improvement

NASCENT study

North American Silver-Coated Endotracheal Tube study

NHSN

National Healthcare Safety Network

SHEA/IDSA

Society for Healthcare Epidemiology of America/IDSA

SMART

Specific, measurable, achievable, relevant, and time bound

VAP

Ventilator-associated pneumonia

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Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.Washington University School of MedicineSt. LouisUSA

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