Noble element coatings on endotracheal tubes for ventilator-associated pneumonia prevention: A systematic review and meta-analysis of randomized controlled trials in emergency care settings

Abstract

Background: Ventilator-associated pneumonia (VAP) is the second most prevalent nosocomial infection in emergency care settings. An emerging strategy to reduce this risk involves coating endotracheal tubes (ETTs) with noble elements, leveraging the antimicrobial properties of elements such as silver, gold, and palladium. This systematic review and meta-analysis aimed to evaluate the effectiveness of noble element coatings on ETTs in reducing VAP incidence rates, mortality, duration of mechanical ventilation, and length of stay in the intensive care unit (ICU).

Methods: Adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a comprehensive search was conducted across 5 databases up to 2024. The quality of the randomized controlled trials was assessed using the updated Cochrane Risk of Bias (RoB) 2 tool. A random-effects meta-analysis was performed using RevMan 5.4 Comprehensive Meta-Analysis software. Statistical heterogeneity among the studies was evaluated using the Higgins I2 value, with P < .05 indicating statistical significance.

Results: Seven randomized controlled trials from 5 countries were identified. Four studies had some concerns regarding bias, 2 had a high RoB, and 1 had a low RoB. Noble metal-coated ETTs resulted in a lower incidence of VAP compared to noncoated ETTs (relative risk, 0.76 [95% confidence interval [CI], 0.60-0.96]). However, there was no significant difference in mortality rates (relative risk, 1.06 [95% CI, 0.93-1.20]), duration of mechanical ventilation (mean difference, -0.10 [95% CI, -1.62 to 1.41]), and ICU stay (mean difference, 0.07 [95% CI, -1.98 to 2.12]).

Conclusion: Noble metal-coated ETTs effectively reduce the incidence of VAP but do not significantly impact mortality rates, the duration of mechanical ventilation, or ICU stay. Therefore, these coated ETTs should be integrated into a holistic care plan addressing all aspects of patient management in emergency care settings.

Figure 1.

Preferred Reporting Items for Systematic Reviews and Meta-Analyses flowchart of the searching and screening studies.

Figure 2.

Incidence of ventilator-associated pneumonia for noble element coated endotracheal tube (ETT) versus standard noncoated ETT. CI = confidence interval, RR = relative risk.

Figure 3.

Mortality rate for noble element coated endotracheal tube (ETT) versus standard noncoated ETT. CI = confidence interval, RR = relative risk.

Figure 4.

Duration of mechanical ventilation for noble element coated endotracheal tube (ETT) versus standard noncoated ETT. CI = confidence interval, MD = mean difference, SD = standard deviation.

Figure 5.

Duration of intensive care unit stays for noble element coated endotracheal tube (ETT) versus standard noncoated ETT. CI = confidence interval, MD = mean difference, SD = standard deviation.