1. Publication
- Title: 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
- Acronym: PreVent 2
- Year & Journal: The Lancet Respiratory Medicine, epublished November 27, 2025 (print: 2026;14(2):141-150)
- Citation: Treggiari MM, Sharp ES, Ohnuma T, et al. Lancet Respir Med. 2026;14(2):141-150. doi:10.1016/S2213-2600(25)00294-2
2. Context & Rationale
Background: Endotracheal tubes with subglottic suction ports and polyurethane cuffs are recommended to reduce microaspiration and ventilator-associated pneumonia (VAP) risk, but their long-term safety/efficacy specifically after emergency intubation had not been rigorously tested.
Research Question/Hypothesis: In patients requiring emergency intubation for acute respiratory failure, does a polyurethane-cuffed endotracheal tube with subglottic suction (PU-EVAC) reduce infection-related ventilator-associated complications (IVAC) or possible VAP compared with a standard PVC tube?
3. Design & Methods
- Study Type: Randomized controlled, phase 2 trial
- Setting & Centers: 2 centers — Oregon Health and Science University and Yale New Haven Hospital, USA
- Population: Adults ≥18y requiring emergency ED/in-hospital intubation for acute respiratory distress/failure (excluded elective OR intubation, children, pregnant women, prisoners)
- Intervention: PU-EVAC — polyurethane-cuffed tube with continuous subglottic suction
- Comparator: Standard PVC-cuffed tube, usual care
- Randomization: 1:1 (fair coin scheme), 1068 patients
- Blinding: Not detailed (device-based, likely open-label)
- Statistical Power & Follow-Up: Primary: IVAC or possible VAP incidence. Secondary: MV duration, ICU LOS, antibiotic use, mortality, 6-month quality of life, cognitive function, laryngeal injury.
4. Key Results
1068 patients randomized.
Outcome | PU-EVAC | Standard PVC | Notes |
IVAC or possible VAP (primary) | Not reduced | — | Clear null |
Ventilator-associated events, MV duration, ICU LOS | No significant difference | — | — |
Antibiotic use/duration, ICU/hospital/6-month mortality | No significant difference | — | — |
6-month QoL, cognitive function, laryngeal injury | No significant difference | — | — |
5. Internal Validity Assessment
Large (1068-patient), two-center trial with comprehensive short- and long-term (6-month) outcome assessment. Overall: Strong — described by an independent commentary as "the largest and most rigorous evaluation of subglottic drainage to date."
6. External Validity Assessment
US, two-center, emergency (not elective) intubation population — specifically fills a gap since prior subglottic-drainage evidence was mostly in elective/general ICU populations rather than emergency intubation specifically.
7. Strengths & Limitations
Strengths: Largest, most rigorous evaluation of subglottic drainage to date; comprehensive short- and long-term outcomes including 6-month QoL/cognition/laryngeal injury.
Limitations: Two-center (not fully multicenter) design; likely open-label.
8. Interpretation & Practice Impact
Does not support routine use of polyurethane-cuffed, subglottic-suction endotracheal tubes over standard tubes for emergency intubation — no benefit on infection outcomes, mortality, or long-term quality of life/cognition. Per the PI: "it is clear from this trial that the answer does not lie with polyurethane cuffs and subglottic secretion drainage."
9. Controversies & Subsequent Evidence
An independent commentary (Infection Control & Hospital Epidemiology reply) states this trial "both supports and strengthens" a guideline panel's decision to downgrade subglottic secretion drainage from an "Essential Practice" to an "Additional Approach" — directly informing infection-prevention guideline revision.
10. Summary & Executive Takeaway
Summary: PreVent 2 randomized 1068 emergency-intubation patients across 2 US centers to a polyurethane-cuffed, subglottic-suction endotracheal tube (PU-EVAC) or standard PVC tube. No significant differences were found in IVAC/possible VAP, ventilator-associated events, MV duration, mortality, or 6-month quality of life, cognition, or laryngeal injury.
Overall Takeaway: Specialized subglottic-suction, polyurethane-cuffed endotracheal tubes provide no benefit over standard tubes for emergency intubation across short- or long-term outcomes — the largest, most rigorous trial of its kind, directly supporting downgrading subglottic secretion drainage from an essential to an optional infection-prevention practice.
11. Bibliography
- Boyer AF, Schoenberg N, Babcock H, et al. Ventilator-associated conditions and infection-related ventilator-associated conditions. Chest. 2015;147:68-81.