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. 2024 Dec 6;11(1):e40793.
doi: 10.1016/j.heliyon.2024.e40793. eCollection 2025 Jan 15.

Conventional endotracheal tubes versus polymer-coated tubes in ventilator-associated pneumonia development: A systematic review and meta-analysis

Oscar Inácio de Mendonça Bisneto  1 , Luanna Paula Garcez de Carvalho Feitoza  2 , Larissa Calixto Hespanhol  1 , Sávio Benvindo Ferreira  1 , Caroline Serafim Dagostin  3 , Roberto Augusto Mazetto Silva Vieira  4 , Lucas Alencar Queiroz  5 , Lucas Chen  6 , Taniela Marli Bes  6 , Ho Yeh Li  7
Affiliations

Conventional endotracheal tubes versus polymer-coated tubes in ventilator-associated pneumonia development: A systematic review and meta-analysis

Oscar Inácio de Mendonça Bisneto et al. Heliyon. .

Abstract

Introduction: Endotracheal tubes (ETT) are used in patients who require ventilatory support. Colonization of ETTs by microorganisms is associated with developing ventilator-associated pneumonia (VAP). Thus, this meta-analysis aims to compare conventional endotracheal tubes with those made using materials designed to prevent colonization.

Methods: This analysis was conducted according to the PRISMA guidelines. During May 2024, we searched multiple databases (PubMed, Cochrane and Embase) for randomized controlled trials (RCT) comparing the incidence of ventilator-associated pneumonia between conventional and coated tubes. Studies with patients with less than 48 h of intubation were excluded. Our primary endpoint was the incidence of VAP in patients intubated with either conventional or coated endotracheal tubes. Statistical analysis was performed using Review Manager Software, and a The Mantel-Haenszel test was performed using a random effects model, and risk ratios (RR) were calculated for binary outcomes. Subgroup analyses were conducted using a fixed effects model when heterogeneity was low. Risk assessment was carried out using the Risk of Bias 2 tool.

Results: Our search identified 6 RCTs eligible in our inclusion criteria, enrolling 2680 patients, with 1361 (50,78 %) undergoing intubation using a polymer-coated tube. The statistical data indicated that coated endotracheal tubes perform better in preventing pneumonia than conventional tubes (RR 0.57 Cl 95 % 0.45-0.90; p < 0.001; I2 0 %). Additionally, conventional tubes were also associated with higher bacterial colonization (47.02 CI 95 % 26.88-68.18; p < 0.01; I2 81 %) compared to coated tubes.

Conclusions: These findings indicate that utilizing a silver-coated endotracheal tube for intubation is more efficacious than conventional tubes, presenting it as a strategy to combat ventilator-associated pneumonia.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram of study screening and selection.
Fig. 2
Fig. 2
Assessment of pneumonia development in intubated patients using silver-coated versus PVC endotracheal tubes.
Fig. 3
Fig. 3
Sensitivity assessment of studies with silver tube.
Fig. 4
Fig. 4
Assessment of pneumonia development in intubated patients using polyurethane tubes versus PVC endotracheal tubes.
Fig. 5
Fig. 5
Sensitivity assessment of studies with polyurethane tube.
Fig. 6
Fig. 6
Assessment of mortality in intubated patients with coated tubes and conventional tubes.
Fig. 7
Fig. 7
Bacterial culture assessment in coated and conventional tubes.
Fig. 8
Fig. 8
Silver and polyurethane in VAP comparison.
Fig. 9
Fig. 9
Total ventilator days in ICU intubated patients with silver tubes and conventional tubes.
Fig. 10
Fig. 10
Sensitivity assessment of studies.
Fig. 11
Fig. 11
ICU Stay duration with polyurethane tube.
Fig. 12
Fig. 12
Sensitivity assessment of studies with polyurethane tubes.
Image 1
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