for the main comparison.
| Silver‐coated ETT compared with non‐coated ETT for VAP | ||||||
| Patient or population: People who are mechanically ventilated Settings: Intensive care unit Intervention: Silver‐coated ETT Comparison: Non‐coated ETT | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No of Participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
| Non‐coated ETT | Silver‐coatedETT | |||||
| Risk of VAP at any time in participants intubated for ≥ 24 hours | 75 per 1000 | 48 per 1000 (32 to 72) |
RR 0.64 (0.43 to 0.96) |
1509 (1 study) | ⊕⊕⊝⊝ Low1,2,3,4,5,6 |
VAP rate was low for all mechanically ventilated participants in the analysis. VAP was diagnosed with new radiographic confirmed infiltrate with qualifying clinical signs followed by quantitative BAL. No standardization of other contemporary VAP prevention strategies. Wide confidence intervals around the estimate of the effect. |
| Risk of VAP within 10 days of intubation in participants intubated for ≥ 24 hours | 67 per 1000 | 35 per 1000 (22 to 56) | RR 0.51 (0.31 to 0.82) | 1509 (1 study) | ⊕⊕⊝⊝ Low1,2,3,4,5,6 |
VAP rate was low for all mechanically ventilated participants in the analysis. No standardization of other contemporary VAP prevention strategies. Wide confidence intervals around the estimate of the effect. |
| Hospital mortality | 266 per 1000 | 290 per 1000 (248 to 344) |
RR 1.09 (0.93 to 1.29) |
1509 (1 study) | ⊕⊕⊝⊝ Low1,2,3,4,5,6 |
The cause of hospital mortality was not clarified in the included studies. Wide confidence intervals around the estimate of the effect. Only included participants who were intubated for 24 hours or longer. |
| Device‐related adverse events | 28 per 1000 | 18 per 1000 (10 to 32) |
RR 0.65 (0.37 to 1.16) |
2081 (2 studies) | ⊕⊕⊝⊝ Low1,2,3,4,5,6 |
Participants who were intubated less than 24 hours were also included. Wide confidence intervals around the estimate of the effect. |
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). BAL: bronchoalveolar lavage; CI: confidence interval; ETT: endotracheal tube; RR: risk ratio; VAP: ventilator‐associated pneumonia | ||||||
| GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate. | ||||||
| GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. | ||||||
1. Study design (‐1): Single‐blinded randomized controlled trial.
2. Low VAP rate.
3. No standardization of other contemporary VAP prevention strategies.
4. Inconsistency (‐0): I² = 0%.
5. Publication bias (‐0): Trial was registered.
6. Imprecision (‐1): Wide confidence intervals around the estimate of the effect.