Document Detail

Modest Reduction in Risk for Ventilator-Associated Pneumonia in Critically ill Patients Receiving Mechanical Ventilation Following Topical Oral Chlorhexidine.
MedLine Citation:
PMID:  23253825     Owner:  NLM     Status:  In-Data-Review    
KEY EXPOSURE/STUDY FACTOR: Lung infection, resulting from aspiration of potential bacterial pathogens, such as Staphylococcus aureus, Streptococcus pneumoniae, or gram-negative rods that first colonize the oral cavity and oropharynx. Oral topical 0.12 % chlorhexidine gluconate, toothbrushing, or both (applied 4 times per day) were tested to determine their impact, if any, on incidence of lung infection in this cohort.
MAIN OUTCOME MEASURE: The CPIS was assessed as the primary outcome variable. This score consists of the sum of points assigned to 6 clinical and laboratory variables (yielding a score from 0 to 12): temperature, white blood cell count, tracheal secretions, oxygenation (calculated as PaO2 divided by the fraction of inspired oxygen), findings on chest radiographs (no infiltrate, diffuse infiltrate, localized infiltrate), and results of culturing of tracheal aspirates (microscopic examination and semiquantitative culture of tracheal secretions). Analysis used in this study examined the effect of interventions on both the range of CPIS scores and on dichotomous categories of the presence (CPIS ≥6) or absence (CPIS <6) of VAP.
MAIN RESULTS: 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 ≥6) among patients who had a CPIS less than 6 at baseline (P = .006). Toothbrushing had no effect on CPIS and did not enhance the effect of chlorhexidine.
CONCLUSIONS: Chlorhexidine oral swabbing was effective in reducing early ventilator-associated pneumonia (VAP) (after 3 days of intervention) in patients in medical, surgical/trauma, and neuroscience ICUs who did not have evidence of lung infection at baseline. This effect was not observed after day 3. Toothbrushing did not reduce the incidence of VAP, and combining toothbrushing and chlorhexidine did not provide additional benefit over use of chlorhexidine alone.
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The journal of evidence-based dental practice     Volume:  12     ISSN:  1532-3390     ISO Abbreviation:  J Evid Based Dent Pract     Publication Date:  2012 Sep 
Date Detail:
Created Date:  2012-12-20     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101083101     Medline TA:  J Evid Based Dent Pract     Country:  United States    
Other Details:
Languages:  eng     Pagination:  15-7     Citation Subset:  D; IM    
Copyright Information:
Copyright © 2012. Published by Mosby, Inc. All rights reserved.
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