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Review
. 2025 Aug 18:91:155222.
doi: 10.1016/j.jcrc.2025.155222. Online ahead of print.

Antimicrobial-coated endotracheal tubes: A narrative review

Abigail K Richardson  1 , Robert G Fuller  2 , Michael D April  3 , Julie A Rizzo  4 , David J Douin  5 , Margaret M Moran  6 , Matthew D Smith  7 , Vikhyat S Bebarta  8 , Steven G Schauer  9
Affiliations
Review

Antimicrobial-coated endotracheal tubes: A narrative review

Abigail K Richardson et al. J Crit Care. .

Abstract

Introduction: Ventilator-associated pneumonia (VAP) is a significant source of morbidity and mortality. We sought to assess the current evidence on antimicrobial-coated endotracheal tubes (ETT) as one potential tool to break the cycle of colonization and infection among ICU patients.

Methods: We conducted a narrative review of available studies focused on the use of antimicrobial-coated ETTs to reduce VAP. The selection process adhered to PRISMA-ScR guidelines.

Results: A total of 58 studies met the inclusion criteria. Silver-based coatings were the most common, with 15 studies, including three randomized controlled trials and two systematic reviews. Of the 15 studies, 12 demonstrated a reduction in bacterial colonization. Two demonstrated delay of VAP onset and three demonstrated reduced VAP incidence. While one study determined there was a decreased mortality, three others determined no statistically significant difference could be proven in overall mortality, hospital stay. Additional research explored coatings composed of a noble metal alloy, zinc, selenium, antibiotics, biocides, and biomimetics. Novel surface modifications such as nano-roughening, micro-patterning, and photodynamic agents showed promise in preventing biofilm formation, though clinical validation remains limited.

Conclusions: Many antimicrobial materials have undergone in vitro appraisal as potential ETT coatings to reduce VAP incidence, but only silver has been extensively tested in RCTs.

Keywords: Antimicrobial; Endotracheal; Noble; Pneumonia; Tube; Ventilator; bacteria.

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Conflict of interest statement

Declaration of competing interest MDA, JAR, DJD, VSB, and SGS have all received funds from the Department of Defense in the form of grants to their institutions. DJD also received funds from the National Institutes of Health in the form of grants to his institution. We have no other conflicts to report.

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