[Oral hygiene with chlorhexidine on the prevention of ventilator-associated pneumonia in intubated patients: a systematic review of randomized clinical trials].

Unidad de Cuidados Intensivos, Fundación Clínica Shaio, Bogotá, Colombia.
Medicina Clínica (Impact Factor: 1.42). 10/2010; 135(11):491-7.
Source: PubMed


Mechanical ventilation is used in about one third of patients in intensive cares units (ICU). Ventilator Associated-Pneumonia (VAP) is a frequent infectious complication, affecting approximately 8 to 28% patients. Strategies to prevent the development of VAP are key factors in the management of ICU patients. There have been proposed several strategies to prevent VAP. One of these is oral hygiene with clorhexidine. We evaluated the effect of chlorhexidine on the prevention of VAP.
We conducted a systematic review of controlled clinical trials evaluating the effect of oral hygiene on VAP prevention. A PubMed search was performed using the following keywords: "oral care OR oral hygiene OR chlorhexidine AND ventilator-associated pneumonia". An independent reviewer evaluated the studies according to the inclusion criteria and extracted the data.
A total of 120 articles were found, and 10 of them met the inclusion criteria. A lack of uniformity was appreciated in the application of chlorhexidine. There was a reduction in the risk of VAP in the chlorhexidine group versus control (OR: 0,56, 95% CI: 0,44-0,73). However, neither a reduction in mortality, nor a length of MV nor an ICU length of stay were seen.
Oral hygiene with chlorhexidine in combination with other strategies for VAP prevention should be included in the patient's ICU care.

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Available from: M. Llauradó, Jan 07, 2014
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    • "95% CI00.39– 0.81). A later meta-analysis published by Carvajal et al. in 2010, including ten randomized trials and 2,978 patients, focused on the efficacy of oral chlorhexidine in reducing the rate of VAP. A lower risk of VAP was found in the intervention group compared to controls (OR00.56, "
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    ABSTRACT: Certain guidelines for the prevention of ventilator-associated pneumonia (VAP) recommend oral care with chlorhexidine, but none refer to the use of a toothbrush for oral hygiene. The role of toothbrush use has received scant attention. Thus, the objective of this study was to compare the incidence of VAP in critical care patients receiving oral care with and without manual brushing of the teeth. This was a randomized clinical trial developed in a 24-bed medical-surgical intensive care unit (ICU). Patients undergoing invasive mechanical ventilation for than 24 h were included. Patients were randomly assigned to receive oral care with or without toothbrushing. All patients received oral care with 0.12 % chlorhexidine digluconate. Tracheal aspirate samples were obtained during endotracheal intubation, then twice a week, and, finally, on extubation. There were no significant differences between the two groups of patients in the baseline characteristics. We found no statistically significant differences between the groups regarding the incidence of VAP (21 of 217 [9.7 %] with toothbrushing vs. 24 of 219 [11.0 %] without toothbrushing; odds ratio [OR] = 0.87, 95 % confidence interval [CI] = 0.469-1.615; p = 0.75). Adding manual toothbrushing to chlorhexidine oral care does not help to prevent VAP in critical care patients on mechanical ventilation.
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    ABSTRACT: Ventilator-associated pneumonia (VAP) remains a frequent and severe complication in endotracheally intubated patients. Strict adherence to preventive measures reduces the risk of VAP. The objective of this paper is to review what has come forward in recent years in the nonpharmacological prevention of VAP. It seems advantageous to implement care bundles rather than single prevention measures. A solid basis of knowledge seems necessary to facilitate implementation and maintain a high adherence level. Continuous educational efforts have a beneficial effect on attitude toward VAP. Intermittent subglottic secretions drainage, continuous lateral rotation therapy, and polyurethane cuffed endotracheal tubes decrease the risk of pneumonia. In an in-vitro setting, an endotracheal tube with a taper-shaped cuff appears to better prevent fluid leakage compared to cylindrical polyurethane or polyvinylchloride cuffed tubes. Cuff pressure control by means of an automatic device and multimodality chest physiotherapy need further investigation, as do some aspects of oral hygiene. New devices and strategies have been developed to prevent VAP. Some of these are promising but need further study. In addition, more attention is being given to factors that might facilitate the implementation process and the challenge of achieving high adherence rates.
    Full-text · Article · Feb 2011 · Current opinion in pulmonary medicine
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    ABSTRACT: Objective: User-friendly scores to assess knowledge of guidelines for prevention of ventilator-associated pneumonia (VAP) are scarce and have mainly evaluated nurses, but not students or physicians. Gaps between knowledge and actual clinical practice have not been sufficiently analyzed. We assessed knowledge of and adherence to guidelines for prevention of VAP among physicians, nurses, and students in adult ICUs. Methods: All adult ICU healthcare workers were invited to complete a 20-point questionnaire. The first part assessed personal knowledge of international guidelines for prevention of VAP; the second part assessed daily clinical practice. Personal knowledge and daily practice were scored from 0 to 10 points. Results: We invited 257 ICU healthcare workers to participate in the study, and 167 (65%) accepted (32/54 physicians, 108/176 nurses, and 27/27 students). The median (IQR) personal knowledge scores for physicians, nurses, and students were 6 (5-7), 5 (4-6), and 5 (4-7), respectively. The median scores for daily clinical practice for physicians and nurses were 5 (4-6) and 4 (3-5), respectively. Healthcare workers with more than 1 year of ICU experience scored significantly better in personal knowledge than those with less experience: 6 (5-7) versus 4 (3-6), P = .004. Conclusions: A simple, easy-to-complete questionnaire enabled us to rapidly evaluate personal knowledge and reported clinical practice in prevention of VAP in large teaching institutions. These scores will be used as baseline figures to assess the impact of educational and intervention campaigns.
    Preview · Article · Dec 2012 · Respiratory care
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