BACKGROUND:Ventilator-associated pneumonia is associated with increased morbidity and mortality. OBJECTIVE: To examine the effects of mechanical (toothbrushing), pharmacological (topical oral chlorhexidine), and combination (toothbrushing plus chlorhexidine) oral care on the development of ventilator-associated pneumonia in critically ill patients receiving mechanical ventilation. METHODS:Critically ill adults in 3 intensive care units were enrolled within 24 hours of intubation in a randomized controlled clinical trial with a 2 x 2 factorial design. Patients with a clinical diagnosis of pneumonia at the time of intubation and edentulous patients were excluded. Patients (n = 547) were randomly assigned to 1 of 4 treatments: 0.12% solution chlorhexidine oral swab twice daily, toothbrushing thrice daily, both toothbrushing and chlorhexidine, or control (usual care). Ventilator-associated pneumonia was determined by using the Clinical Pulmonary Infection Score (CPIS). RESULTS: The 4 groups did not differ significantly in clinical characteristics. At day 3 analysis, 249 patients remained in the study. Among patients without pneumonia at baseline, pneumonia developed in 24% (CPIS >or=6) by day 3 in those treated with chlorhexidine. When data on all patients were analyzed together, mixed models analysis indicated no effect of either chlorhexidine (P = .29) or toothbrushing (P = .95). However, chlorhexidine significantly reduced the incidence of pneumonia on day 3 (CPIS >or=6) among patients who had CPIS <6 at baseline (P = .006). Toothbrushing had no effect on CPIS and did not enhance the effect of chlorhexidine. CONCLUSIONS:Chlorhexidine, but not toothbrushing, reduced early ventilator-associated pneumonia in patients without pneumonia at baseline.
RCT Entities:
BACKGROUND: Ventilator-associated pneumonia is associated with increased morbidity and mortality. OBJECTIVE: To examine the effects of mechanical (toothbrushing), pharmacological (topical oral chlorhexidine), and combination (toothbrushing plus chlorhexidine) oral care on the development of ventilator-associated pneumonia in critically illpatients receiving mechanical ventilation. METHODS:Critically ill adults in 3 intensive care units were enrolled within 24 hours of intubation in a randomized controlled clinical trial with a 2 x 2 factorial design. Patients with a clinical diagnosis of pneumonia at the time of intubation and edentulouspatients were excluded. Patients (n = 547) were randomly assigned to 1 of 4 treatments: 0.12% solution chlorhexidine oral swab twice daily, toothbrushing thrice daily, both toothbrushing and chlorhexidine, or control (usual care). Ventilator-associated pneumonia was determined by using the Clinical Pulmonary Infection Score (CPIS). RESULTS: The 4 groups did not differ significantly in clinical characteristics. At day 3 analysis, 249 patients remained in the study. Among patients without pneumonia at baseline, pneumonia developed in 24% (CPIS >or=6) by day 3 in those treated with chlorhexidine. When data on all patients were analyzed together, mixed models analysis indicated no effect of either chlorhexidine (P = .29) or toothbrushing (P = .95). However, chlorhexidine significantly reduced the incidence of pneumonia on day 3 (CPIS >or=6) among patients who had CPIS <6 at baseline (P = .006). Toothbrushing had no effect on CPIS and did not enhance the effect of chlorhexidine. CONCLUSIONS:Chlorhexidine, but not toothbrushing, reduced early ventilator-associated pneumonia in patients without pneumonia at baseline.
Authors: Jeanne E Zack; Teresa Garrison; Ellen Trovillion; Darnetta Clinkscale; Craig M Coopersmith; Victoria J Fraser; Marin H Kollef Journal: Crit Care Med Date: 2002-11 Impact factor: 7.598
Authors: Hilary M Babcock; Jeanne E Zack; Teresa Garrison; Ellen Trovillion; Marilyn Jones; Victoria J Fraser; Marin H Kollef Journal: Chest Date: 2004-06 Impact factor: 9.410
Authors: J Vallés; A Artigas; J Rello; N Bonsoms; D Fontanals; L Blanch; R Fernández; F Baigorri; J Mestre Journal: Ann Intern Med Date: 1995-02-01 Impact factor: 25.391
Authors: Nancy J Ames; Pawel Sulima; Jan M Yates; Linda McCullagh; Sherri L Gollins; Karen Soeken; Gwenyth R Wallen Journal: Am J Crit Care Date: 2011-09 Impact factor: 2.228
Authors: Heather L Evans; Keir Warner; Eileen M Bulger; Sam R Sharar; Ronald V Maier; Joseph Cuschieri Journal: Surg Infect (Larchmt) Date: 2011-09-20 Impact factor: 2.150
Authors: Ana Paula Silva; Pedro Caruso; Graziella Chagas Jaguar; Paulo Andre G Carvalho; Fabio Abreu Alves Journal: Support Care Cancer Date: 2014-04-22 Impact factor: 3.603