byYale School of Medicine

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Modified endotracheal tubes designed to reduce patient pneumonia risk failed to improve outcomes compared to standard breathing tubes, researchers report in a new study.

Results of the randomized controlled phase 2 trial called PreVent2 have been published inLancet Respiratory Medicine.

Emily Sharp, Ph.D., Associate Professor of Neurology at Yale School of Medicine, was the trial's site principal investigator at Yale.

"Patients requiring emergency intubation for respiratory failure are at risk of several complications, including ventilator associated pneumonia" said Miriam Treggiari, MD, professor of anesthesiology at Duke University School of Medicine and principal investigator of the study.

"Preventing these potentially serious complications is a high management priority," Treggiari adds, "but it is clear from this trial that the answer does not lie with polyurethane cuffs and subglottic secretion drainage."

Ventilator-associated pneumonia (VAP) is a dangerous lung infection associated with worse quality of life, cognitive function, and general health outcomes. The tubes examined in this study, calledPU-EVAC, attempt to reduce pneumonia risk by replacing conventional polyvinylchloride (PVC) cuffs with more leakproof polyurethane cuffs, and adding a built-in suction port to keep fluids from leaking into patients' airways.

In the trial, 1,068 adult patients with acute respiratory failure were intubated either with the specialized PU-EVAC tube, or with a standard, PVC endotracheal tube.

Researchers found similar rates of suspected pneumonia (6% in the PU-EVAC group vs. 5% in the PVC group) and overall infections (8% in the PU-EVAC group vs. 6% in the PVC group), and reported no significant differences in throat injury risk or long-term recovery.

The study represents the most in-depth trial of the specialized breathing tubes to date, as guidelines continue to evolve.

"The CDC and the Society for Healthcare Epidemiology of America were recommending PU-EVAC on the basis of prior trials and meta-analyses to reduce pneumonia, duration of ICU stay and ventilation," Sharp said.

"While recent guidelines downgraded the recommendation in 2022, this study affirms the lack of benefit of PU-EVAC endotracheal tubes and underscores the high morbidity, mortality, and long-term cognitive challenges among patients requiring emergency intubation for acute respiratory failure."

More information Miriam M Treggiari et al, Hospital and long-term outcomes for subglottic suction and polyurethane cuff versus standard endotracheal tubes in emergency intubation (PreVent 2): a randomised controlled phase 2 trial, The Lancet Respiratory Medicine (2025). DOI: 10.1016/s2213-2600(25)00294-2 Journal information: Lancet Respiratory Medicine

Provided by Yale School of Medicine