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 reduced VAP compared to the PVC cylindrical cuff, further research is needed to explore its broader applicability.

Implications for clinical practice: Prioritizing the use of the silver-coated PVC tapered cuff in ICU settings may help reduce VAP and bacterial colonization. Future research should explore the synergistic effects of antimicrobial coating and cuff design optimization. Traditional PVC cylindrical cuffs remain a viable alternative.