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Critical Care

, 13:R117

First Online: 15 July 2009Received: 23 June 2009Accepted: 15 July 2009


IntroductionDental plaque biofilms are colonized by respiratory pathogens in mechanically-ventilated intensive care unit patients. Thus, improvements in oral hygiene in these patients may prevent ventilator-associated pneumonia. The goal of this study was to determine the minimum frequency once or twice a day for 0.12% chlorhexidine gluconate application necessary to reduce oral colonization by pathogens in 175 intubated patients in a trauma intensive care unit.

MethodsA randomized, double-blind, placebo-controlled clinical trial tested oral topical 0.12% chlorhexidine gluconate or placebo vehicle alone, applied once or twice a day by staff nurses. Quantitation of colonization of the oral cavity by respiratory pathogens teeth-denture-buccal mucosa was measured.

ResultsSubjects were recruited from 1 March, 2004 until 30 November, 2007. While 175 subjects were randomized, microbiologic baseline data was available for 146 subjects, with 115 subjects having full outcome assessment after at least 48 hours. Chlorhexidine reduced the number of Staphylococcus aureus, but not the total number of enterics, Pseudomonas or Acinetobacter in the dental plaque of test subjects. A non-significant reduction in pneumonia rate was noted in groups treated with chlorhexidine compared with the placebo group OR = 0.54, 95% CI: 0.23 to 1.25, P = 0.15. No evidence for resistance to chlorhexidine was noted, and no adverse events were observed. No differences were noted in microbiologic or clinical outcomes between treatment arms.

ConclusionsWhile decontamination of the oral cavity with chlorhexidine did not reduce the total number of potential respiratory pathogens, it did reduce the number of S. aureus in dental plaque of trauma intensive care patients.

Trial Registrationclinicaltrials.gov NCT00123123.

AbbreviationsANOVAanalysis of variance

APACHEAcute Physiology and Chronic Health Evaluation

BqBALblind quantitative bronchoalveolar lavage

cfucolony forming units

CHXchlorhexidine gluconate

CIconfidence interval

CPISclinical pulmonary infection score

ECMCErie County Medical Center

FiO2fraction of inspired oxygen

HRhazards ratio

MV-ICUmechanically ventilated, intensive care unit

ORodds ratio

PaO2partial pressure of arterial oxygen

PRPspotential respiratory bacterial pathogens

SIDsubject Identification Numbers

VAPventilator-associated pneumonia.

Electronic supplementary materialThe online version of this article doi:10.1186-cc7967 contains supplementary material, which is available to authorized users.

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Autor: Frank A Scannapieco - Jihnhee Yu - Krishnan Raghavendran - Angela Vacanti - Susan I Owens - Kenneth Wood - Joseph M Mylo

Fuente: https://link.springer.com/

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