Chlorhexidine decreases the risk of ventilator‐associated pneumonia in intensive care unit patients: a randomized clinical trial

Abstract

Özçaka Ö, Başoğlu ÖK, Buduneli N, Taşbakan MS, Bacakoğlu F, Kinane DF. Chlorhexidine decreases the risk of ventilator‐associated pneumonia in intensive care unit patients: a randomized clinical trial. J Periodont Res 2012; 47: 584–592. © 2012 John Wiley & Sons A/S Background and Objective: The aim was to evaluate whether oral swabbing with 0.2% chlorhexidine gluconate (CHX) decreases the risk of ventilator‐associated pneumonia (VAP) in intensive care unit (ICU) patients. Material and Methods: Sixty‐one dentate patients scheduled for invasive mechanical ventilation for at least 48 h were included in this randomized, double‐blind, controlled study. As these patients were variably incapacitated, oral care was provided by swabbing the oral mucosa four times/d with CHX in the CHX group (29 patients) and with saline in the control group (32 patients). Clinical periodontal measurements were recorded, and lower‐respiratory‐tract specimens were obtained for microbiological analysis on admission and when VAP was suspected. Pathogens were identified by quantifying colonies using standard culture techniques. Results: Ventilator‐associated pneumonia developed in 34/61 patients (55.7%) within 6.8 d. The VAP development rate was significantly higher in the control group than in the CHX group (68.8% vs. 41.4%, respectively; p = 0.03) with an odds ratio of 3.12 (95% confidence interval = 1.09–8.91). Acinetobacter baumannii was the most common pathogen (64.7%) of all species identified. There were no significant differences between the two groups in clinical periodontal measurements, VAP development time, pathogens detected or mortality rate. Conclusion: The finding of the present study, that oral care with CHX swabbing reduces the risk of VAP development in mechanically ventilated patients, strongly supports its use in ICUs and indeed the importance of adequate oral hygiene in preventing medical complications.

Effectiveness of Intraoral Chlorhexidine Protocols in the Prevention of Ventilator-Associated Pneumonia: Meta-Analysis and Systematic Review

“…[8][9][10]12,18,24 On the contrary, in some others, chlorhexidine was associated with mechanical debridement. 14,15,17,19 Therefore, an analysis was undertaken to assess the effectiveness of chlorhexidine used alone and in association with mechanical means for the prevention of VAP (Fig.…”

“…9,10,12,14,18,19,22,24 Whereas study subjects and personnel were blinded in only 8 trials, 8,12,15,17,18,21,22,25 outcome assessors were blinded in all studies. [8][9][10]12,14,15,[17][18][19]21,22,24,25 Incomplete outcome data were adequately addressed in 5 studies. 12,15,21,24,25 In 3 studies, 9,17,18 the reasons for missing data in each group were not provided.…”

“…Details related to the method of randomization were provided in all studies. [8][9][10]12,14,15,[17][18][19]21,22,24,25 Allocation concealment was adequately described only in 4 studies. 8,15,17,21 Moreover, one study 25 reported that allocation was concealed but did not provide details of the concealment.…”

“…Studies enrolled subjects expected to require orotracheal or nasotracheal intubation and mechanical ventilation. [8][9][10]12,14,15,[17][18][19]21,22,24,25 Among these, some studies required mechanical ventilation for at least 48 h. 10,12,22,24 Other studies only included subjects with medical conditions suggesting an ICU stay of Ն48 h, 15 3 d, 18 or 5 d 8,9 (Table 1). In 3 studies, research subjects were children.…”

“…Among these antiseptics, chlorhexidine gluconate has attracted considerable attention, as evidenced by numerous randomized controlled clinical trials that have investigated the effect of oral chlorhexidine use in VAP prevention. [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] Results from the aforementioned randomized controlled trials and meta-analyses [26][27][28][29][30] that analyzed the effect of oral care with chlorhexidine on VAP prevention are conflicting. Discrepant findings may have resulted from differences in study populations, diagnostic criteria for VAP, chlorhexidine concentration, and frequency of use.…”