贵金属合金气管导管在呼吸机相关性肺炎预防中的效果：一项随机临床试验。

Efficacy of Noble Metal–alloy Endotracheal Tubes in Ventilator-associated Pneumonia Prevention: a Randomized Clinical Trial.

机构信息

Toxicology and Intensive Care Unit, Clinical Emergency Hospital Bucharest, Bucharest, Romania

Anestesiology and Intensive Care Clinical, Emergency Hospital Bucharest, Bucharest, Romania

出版信息

Balkan Med J. 2022 May 24;39(3):167-171. doi: 10.4274/balkanmedj.galenos.2021.2021-7-86. Epub 2022 Mar 25.

DOI:10.4274/balkanmedj.galenos.2021.2021-7-86

PMID:35332771

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9136541/

Abstract

BACKGROUND

Endotracheal tube (ETT) is an important risk factor for the development of Ventilator-associated pneumonia (VAP), as it acts as a reservoir for infectious microorganisms and bypasses the host’s defenses. One of the preventive measures for VAP is endotracheal tube composition. It has been reported that biofilm formation is reduced by using ETTs coated with pure silver or silver compounds. However, noble metal-alloy ETTs have not been adequately studied.

AIMS

To evaluate the efficacy of noble metal alloy ETT (coated Bactiguard Infection Protection ETTs) in preventing VAP compared to standard non-coated ETTs in patients requiring ≥ 48 hours of mechanical ventilation and presenting for coma due to drug intoxication.

STUDY DESIGN

Randomized controlled study.

METHODS

Participants were randomized using sealed envelopes with a concealed 1:1 allocation to either the intervention group or the control group. The intervention group used a noble metal–alloy ETT, while the control group received standard ETT. The primary outcomes were the incidence of VAP (per ventilated patients) and the duration of mechanical ventilation.

RESULTS

Initially, a total of 188 patients were assessed for eligibility, and the final allocation group consisted of 180 patients, who were subsequently randomized into the intervention group (n = 97) and control group (n = 83). The incidence of VAP in the intervention and control groups was 27.83% and 43.16% ( = 0.03), and the VAP ratio per 1000 ventilation days was 51.26/1000 and 83.38/1000 ( = 0.01), respectively. The mean durations of mechanical ventilation were 3.2 ± 0.78 in the intervention group and 5.03 ± 1.88 in the control group ( = 0.22). There was no statistically significant difference between groups in terms of mortality and duration of hospital stay.

CONCLUSION

Noble metal-alloy ETT reduces the incidence of VAP, ventilation days, and ICU stay for patients in mechanical ventilation.

摘要

背景

气管内导管（ETT）是呼吸机相关性肺炎（VAP）发展的重要危险因素，因为它充当了感染微生物的储库，并绕过了宿主的防御机制。VAP 的预防措施之一是气管内导管的组成。据报道，使用涂有纯银或银化合物的 ETT 可减少生物膜的形成。然而，对于贵金属合金 ETT，尚未进行充分的研究。

目的

评估与标准非涂层 ETT 相比，在需要机械通气≥48 小时且因药物中毒而昏迷的患者中，使用涂有 Bactiguard 抗感染保护涂层的贵金属合金 ETT（涂有 Bactiguard 抗感染保护 ETT）预防 VAP 的效果。

研究设计

随机对照研究。

方法

参与者使用密封信封进行随机分组，信封内装有隐藏的 1:1 分配，分为干预组或对照组。干预组使用贵金属合金 ETT，对照组则使用标准 ETT。主要结局为 VAP（每例通气患者）的发生率和机械通气的持续时间。

结果

最初评估了 188 例患者的纳入标准，最终纳入的分组患者为 180 例，随后将其随机分为干预组（n=97）和对照组（n=83）。干预组和对照组的 VAP 发生率分别为 27.83%和 43.16%（=0.03），每 1000 通气日的 VAP 发生率分别为 51.26/1000 和 83.38/1000（=0.01）。干预组和对照组机械通气的平均时间分别为 3.2±0.78 小时和 5.03±1.88 小时（=0.22）。两组在死亡率和住院时间方面无统计学差异。