{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T20:42:06Z","timestamp":1780432926723,"version":"3.54.1"},"reference-count":28,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2016,1,1]],"date-time":"2016-01-01T00:00:00Z","timestamp":1451606400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2016,1,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Rationale<\/jats:title>\n                    <jats:p>Ventilator-associated pneumonia (VAP) is a prevalent and costly nosocomial infection related to instrumentation of the airway with an endotracheal tube (ETT), enabling microaspiration of contaminated secretions. Modification of the ETT design to reduce microaspiration and\/or biofilm formation may play an important role in VAP prevention. However, there is insufficient evidence to provide strong recommendations regarding the use of modified ETT and unaddressed safety concerns.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>We performed a pilot randomized controlled trial comparing two modified ETTs designed specifically to prevent VAP, with the standard ETT, to test the feasibility of and inform planning for a large, pivotal, randomized trial.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This study was conducted with institutional review board approval under exception from informed consent. We randomized in a blinded fashion patients undergoing emergency endotracheal intubation both out of and in hospital to receive one of three different ETT types: (1) a polyurethane-cuffed tube (PUC-ETT), (2) a polyurethane-cuffed tube equipped with a port for continuous aspiration of subglottic secretions (PUC-CASS-ETT), or a (3) standard polyvinylchloride-cuffed tube (PVC-ETT). In addition to investigating feasibility and safety, the study coprimary end points were tracheal bacterial colonization reaching a cfu count &amp;gt;106 cfu per milliliter and the incidence of invasively diagnosed VAP.<\/jats:p>\n                    <jats:p>Measurements and Main Results: A total of 102 subjects were randomized and met the eligibility criteria. Randomization procedures performed well and integrity of blinding at randomization was maintained. The majority of intubations occurred in the hospital setting (n\u2009=\u200977), and the remainder occurred out of hospital (n\u2009=\u200925). Compared with the PVC-ETT, there were no significant differences in tracheal colonization for PUC-ETT (odds ratio [OR], 0.98; 95% confidence interval [CI], 0.31\u20133.09) or for PUC-CASS-ETT (OR, 1.26; 95% CI, 0.42\u20133.76). There were no differences in the risk of invasively diagnosed VAP (OR, 1.14; 95% CI, 0.21\u20136.08 for PUC-ETT; OR, 1.47; 95% CI, 0.30\u20137.10 for PUC-CASS-ETT), or of clinically diagnosed VAP by either clinical signs or chest radiograph criteria. We did not observe unexpected or serious adverse events related to the devices.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>A randomized trial of ETTs inserted during emergency intubation for the prevention of VAP is feasible and did not appear to carry heightened safety concerns. These preliminary data did not suggest different patterns of tracheal colonization or occurrence of VAP among the study groups.<\/jats:p>\n                    <jats:p>Clinical trial registered with www.clinicaltrials.gov (NCT01744483).<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1513\/annalsats.201506-346oc","type":"journal-article","created":{"date-parts":[[2015,11,2]],"date-time":"2015-11-02T16:29:10Z","timestamp":1446481750000},"page":"72-80","source":"Crossref","is-referenced-by-count":27,"title":["Randomized Pilot Trial of Two Modified Endotracheal Tubes To Prevent Ventilator-associated Pneumonia"],"prefix":"10.1093","volume":"13","author":[{"given":"Steven","family":"Deem","sequence":"first","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, and"},{"name":"Physicians Anesthesia Service and Swedish Medical Group, Swedish Medical Center, Seattle, Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Yanez","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, University of Washington, Seattle, Washington"},{"name":"Department of Public Health and Preventive Medicine, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Sissons-Ross","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jo Ann","family":"Elrod Broeckel","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen","family":"Daniel","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, University of Washington, Seattle, Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miriam","family":"Treggiari","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, and"},{"name":"Department of Public Health and Preventive Medicine, and"},{"name":"Department of Anesthesiology and Perioperative Medicine, Oregon Health and Sciences University, Portland, Oregon"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2016,1,1]]},"reference":[{"key":"2026020502524768100_bib1","doi-asserted-by":"crossref","first-page":"1396","DOI":"10.1097\/01.CCM.0000128569.09113.FB","article-title":"Prevention of hospital-associated pneumonia and ventilator-associated pneumonia","volume":"32","author":"Kollef","year":"2004","journal-title":"Crit Care Med"},{"key":"2026020502524768100_bib2","doi-asserted-by":"crossref","first-page":"1985","DOI":"10.1097\/CCM.0b013e318218a4d9","article-title":"Subglottic secretion drainage for the prevention of ventilator-associated pneumonia: a systematic review and meta-analysis","volume":"39","author":"Muscedere","year":"2011","journal-title":"Crit Care Med"},{"key":"2026020502524768100_bib3","first-page":"1046","article-title":"New endotracheal tubes designed to prevent ventilator-associated pneumonia: do they make a difference?","volume":"55","author":"Deem","year":"2010","journal-title":"Respir Care"},{"key":"2026020502524768100_bib4","doi-asserted-by":"crossref","first-page":"2071","DOI":"10.1097\/01.CCM.0000142575.86468.9B","article-title":"Evaluation of continuous aspiration of subglottic secretion in an in vivo study","volume":"32","author":"Berra","year":"2004","journal-title":"Crit Care Med"},{"key":"2026020502524768100_bib5","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1007\/s00134-003-2077-4","article-title":"Airway colonisation in long-term mechanically ventilated patients. 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