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Published on: September 24, 2020
Ceragenin-Coated Endotracheal Tubes for the Reduction of Ventilator-Associated Pneumonia: A Prospective,
John Muscedere1, Patrick A Norman2, Christine D'Arsigney1
1Department of Critical Care Medicine, Queen's University, Kingston, ON, Canada.
Objective:
To evaluate the impact of Ceragenin-coated endotracheal tubes (CSA ETTs) on the incidence of ventilator-associated pneumonia (VAP) in critically ill adults and assess feasibility of conducting a multicenter study.
Design:
Prospective, crossover, interrupted time series implementation study.
Setting:
A tertiary, medical-surgical-ICU in Kingston, Ontario, Canada.
Patients:
A total of 260 mechanically ventilated adults with 100 receiving CSA ETTs and 160 subglottic suction ETTs (SSETTs).
Interventions:
After a run-in period, patients received either CSA ETTs or SSETT according to a four-period crossover implementation study. ETT type was alternated at the hospital level during each study period.
Measurements And Main Results:
The primary outcome was VAP incidence. VAP occurred in 19 of 100 (19%) of patients treated with CSA ETTs and 24 of 160 (15%) with standard ETTs, adjusted relative risk (RR) (95% CI), 1.22 (0.70-2.13), p = 0.40. In secondary analyses, CSA ETT patients had more 28-day antibiotic-free days (mean ± sd: 14.7 ± 10.4 vs.11.8 ± 10.9, p = 0.047), ventilation-free days (15.7 ± 10.7 vs. 12.4 ± 11.5, p = 0.03), and lower ICU (n [%]: 20 (20%) vs. 57 (36%), p = 0.01 and hospital mortality: 25 (25%) vs. 68 (43%), p value of equals to 0.004. The CSA ETT was implemented without major difficulties, and acceptability among clinicians was high. No serious device-related adverse events were reported.
Conclusions:
Although patients treated with CSA ETTs had similar rates of VAP than those receiving SSETT, better secondary clinical outcomes, including mortality occurred with the CSA ETTs. The conduct of this cross-over, implementation study was feasible. There is a need for further research to confirm our findings in a larger, randomized, multicenter study.
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