What does this research mean for the field?

Ceragenin-coated endotracheal tubes do not significantly reduce the incidence of ventilator-associated pneumonia compared to subglottic suction tubes, but they are associated with improved secondary clinical outcomes including lower mortality and increased ventilator-free days. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

This study aims to assess the effectiveness of ceragenin-coated endotracheal tubes in reducing ventilator-associated pneumonia in critically ill patients.

March 22, 2026Open Access

Ceragenin-Coated Endotracheal Tubes for the Reduction of Ventilator-Associated Pneumonia: A Prospective, Longitudinal, Crossover, Interrupted Time, Implementation Study (CEASE VAP Study)

Key Points

This study aims to assess the effectiveness of ceragenin-coated endotracheal tubes in reducing ventilator-associated pneumonia in critically ill patients.
Prospective crossover design with interrupted time series implementation.
Conducted in a medical-surgical ICU setting.
Comparison between patients receiving ceragenin-coated endotracheal tubes and standard suction endotracheal tubes.
Measurement of primary and secondary outcomes including rates of VAP and mortality.
VAP occurred in 19% of patients with ceragenin-coated tubes compared to 15% with standard tubes (p=0.40).
Patients with ceragenin-coated tubes had more antibiotic-free days (14.7 days vs. 11.8 days, p=0.047).
Higher ventilation-free days observed in the ceragenin group (15.7 days vs. 12.4 days, p=0.03).
Lower ICU mortality rates (20% vs. 36%, p=0.01) and hospital mortality (25% vs. 43%, p=0.004) in the ceragenin group.

Abstract

OBJECTIVE: To evaluate the impact of Ceragenin-coated endotracheal tubes (CSA ETTs) on the incidence of ventilator-associated pneumonia (VAP) in critically ill adults and assess feasibility of conducting a multicenter study. DESIGN: Prospective, crossover, interrupted time series implementation study. SETTING: A tertiary, medical-surgical-ICU in Kingston, Ontario, Canada. PATIENTS: A total of 260 mechanically ventilated adults with 100 receiving CSA ETTs and 160 subglottic suction ETTs (SSETTs). INTERVENTIONS: After a run-in period, patients received either CSA ETTs or SSETT according to a four-period crossover implementation study. ETT type was alternated at the hospital level during each study period. MEASUREMENTS AND MAIN RESULTS: The primary outcome was VAP incidence. VAP occurred in 19 of 100 (19%) of patients treated with CSA ETTs and 24 of 160 (15%) with standard ETTs, adjusted relative risk (RR) (95% CI), 1.22 (0.70–2.13), p = 0.40. In secondary analyses, CSA ETT patients had more 28-day antibiotic-free days (mean ± sd : 14.7 ± 10.4 vs.11.8 ± 10.9, p = 0.047), ventilation-free days (15.7 ± 10.7 vs. 12.4 ± 11.5, p = 0.03), and lower ICU ( n %: 20 (20%) vs. 57 (36%), p = 0.01 and hospital mortality: 25 (25%) vs. 68 (43%), p value of equals to 0.004. The CSA ETT was implemented without major difficulties, and acceptability among clinicians was high. No serious device-related adverse events were reported. CONCLUSIONS: Although patients treated with CSA ETTs had similar rates of VAP than those receiving SSETT, better secondary clinical outcomes, including mortality occurred with the CSA ETTs. The conduct of this cross-over, implementation study was feasible. There is a need for further research to confirm our findings in a larger, randomized, multicenter study.

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Cite This Study

Muscedere et al. (Fri,) studied this question.

synapsesocial.com/papers/69bf898bf665edcd009e948f https://doi.org/https://doi.org/10.1097/cce.0000000000001382

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