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Research In Brief

This article was originally published in The Gray Sheet

Executive Summary

Silver-coated endotracheal tubes: Use of the devices to prevent ventilator-associated pneumonia should be restricted to high-risk patients until further data confirms their effectiveness, according to an editorial in the Aug. 20 issue of the Journal of the American Medical Association. Jean Chastre, M.D., of Univeriste Pierre et Marie Curie, Paris, asserts the exact benefit of silver-coated tubes remains unknown despite promising results from a study of Bard's first-in-class Agento IC silver-coated tube in ventilator-acquired pneumonia (VAP), published in the same issue of JAMA. Chastre cites a number of limitations of Bard's NASCENT trial: The study was not blinded, which may have introduced bias, and quantitative culture results from bronchoalveolar lavage may have been negatively influenced by introducing new antibiotics after the onset of symptoms but before obtaining respiratory secretions, Chastre notes. Also, the trial's enrollment was unbalanced in the proportion of patients with preexisting chronic obstructive pulmonary disease - a known risk factor for VAP - favoring the Agento IC group. The 2,003-patient NASCENT trial showed that the incidence of VAP in patients intubated for 24 hours or longer with Agento IC was 4.8%, compared to 7.5% in patients given Mallinckrodt's Hi-Lo endotracheal tube. Agento IC gained 510(k) clearance in November 2007
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