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

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; I ² 0 %). Additionally, conventional tubes were also associated with higher bacterial colonization (47.02 CI 95 % 26.88–68.18; p < 0.01; I ² 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.