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. 2022 Jan 4;12(1):1.
doi: 10.1186/s13613-021-00961-y.

Prevention of ventilator-associated pneumonia by noble metal coating of endotracheal tubes: a multi-center, randomized, double-blind study

Pierre Damas  1 , Caroline Legrain  2 , Bernard Lambermont  3 , Nadia Dardenne  4 , Julien Guntz  2 , Grâce Kisoka  3 , Pierre Demaret  2 , Anne-Françoise Rousseau  3 , Laurent Jadot  2 , Sonia Piret  3 , Didier Noirot  2 , Axelle Bertrand  3 , Anne-Françoise Donneau  4 , Benoît Misset  3
Affiliations

Prevention of ventilator-associated pneumonia by noble metal coating of endotracheal tubes: a multi-center, randomized, double-blind study

Pierre Damas et al. Ann Intensive Care. .

Abstract

Background: Ventilator-associated pneumonia (VAP) causes increased mortality, prolonged hospital stay and increased healthcare costs. Prevention of VAP in intensive care units (ICUs) is currently based on several measures, and application of noble metal coating on medical devices has been shown to inhibit the bacterial adherence of microorganisms to the surface. The objective of this study was to evaluate the potential benefit of noble metal coating of endotracheal tubes for the prevention of VAP.

Methods: This was a multi-center, randomized, controlled, double-blind, prospective study including ventilated patients from nine ICUs from four hospital sites in Belgium. Patients were randomly intubated with identical appearing noble metal alloy (NMA) coated (NMA-coated group) or non-coated (control group) endotracheal tubes (ETT). Primary endpoint was the incidence of VAP. Secondary endpoints were the proportion of antibiotic days during ICU stay and tracheal colonization by pathogenic bacteria.

Results: In total, 323 patients were enrolled, 168 in the NMA-coated group and 155 in the control group. During ventilation, VAP occurred in 11 patients (6.5%) in the NMA-coated group and in 18 patients (11.6%) in the control group (p = 0.11). A higher delay in VAP occurrence was observed in the NMA-coated group compared with the control group by Cox proportional hazards regression analysis (HR 0.41, 95% CI 0.19-0.88, p = 0.02). The number of antibiotic days was 58.8% of the 1,928 ICU days in the NMA-coated group and 65.4% of the 1774 ICU days in the control group (p = 0.06). Regarding tracheal colonization, bacteria occurred in 38 of 126 patients in the NMA-coated group (30.2%) and in 37 of 109 patients in the control group (33.9%) (p = 0.57).

Conclusions: This study provides preliminary evidence to support the benefit of noble metal coating in the prevention of VAP. A confirmatory study in a larger population would be valuable.

Trial registration: Clinical trial number: NCT04242706 ( http://www.clinicaltrials.gov ).

Keywords: Antibiotic consumption, intubation; Endotracheal tube; Infection; Noble metal coating; Ventilator-associated pneumonia.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart of patients admitted in the participating intensive care units during the study. BIP Bactiguard Infection Protection; ETT endotracheal tube; Evac evacuation; NMA noble metal alloy
Fig. 2
Fig. 2
Cumulative rates of patients remaining free of a suspected ventilator-associated pneumonia and b confirmed ventilator-associated pneumonia using the Kaplan–Meier method
See this image and copyright information in PMC

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