Tracheal tube cuff materials, shapes, and coatings in the prevention of ventilator-associated pneumonia: a network meta-analysis and systematic review
Abstract
OBJECTIVES
To compare the effectiveness of various endotracheal tube (ETT) cuff materials, shapes, and antimicrobial coatings in preventing ventilator-associated pneumonia (VAP) through a network meta-analysis.
METHODS
Six databases were searched up to February 2025 for relevant randomized controlled trials (RCTs). Data analysis was performed using R software.
RESULTS
A total of 22 RCTs involving 5305 intensive care unit (ICU) patients and nine types of ETT cuffs were included. The analysis showed that the Venner-PneuX (VPX) cuff significantly reduced VAP incidence compared to the polyvinyl chloride (PVC) cylindrical cuff (OR = 0.46, 95 % CI = 0.22-0.92). Similarly, the silver-coated PVC tapered cuff significantly reduced VAP risk compared to the PVC cylindrical cuff (OR = 0.54, 95 % CI = 0.29-0.98). The silver-coated PVC tapered cuff (Ag-PVC-Tap-Cuff) also significantly lowered bacterial colonization compared to the VPX cuff (OR = 0.11, 95 % CI = 0.01-0.74) and the PVC tapered cuff (OR = 0.26, 95 % CI = 0.06-0.89). No significant differences were observed among cuff types regarding mortality, mechanical ventilation duration, or ICU length of stay. Overall ranking analysis indicated that the silver-coated PVC cuff was the most effective in preventing VAP (72 %) and bacterial airway colonization (95 %).
CONCLUSIONS
Based on our findings, the silver-coated tapered PVC cuff shows promise for reducing VAP and bacterial colonization in ICU patients. Although the VPX significantly…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid.
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