Ventilator-associated pneumonia (VAP) can be life threatening and its link with good mouth care is a topic we have covered before on Dental Elf (18th April 2012 and 28th Nov 2011). The aim of this study 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.
What did they do
61 dentate patients who were scheduled for invasive mechanical ventilation for at least 48 h were randomised to either, oral mucosal swabbing four times a day with CHX (n=29 patients) or saline (control group n=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.
What did they find
- 34/61 patients (55.7%) developed VAP within 6.8 days.
- VAP development rate was significantly higher in the controls compared with 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 identified.
- There were no significant differences between the two groups in clinical periodontal measurements, VAP development time, pathogens detected or mortality rate.
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.
Ozçaka O, Başoğlu OK, 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 Periodontal Res. 2012 Feb 29. doi: 10.1111/j.1600-0765.2012.01470.x. [Epub ahead of print] PubMed PMID: 22376026.
Only the abstract of the papers was available for review and using this data calculating the NumberNeeded to Treat (NNT) give a figure of 4 . However, the results are in line with a recent systematic review published in the Lancet by Labeau et al.
Labeau SO, Van de Vyver K, Brusselaers N, Vogelaers D, Blot SI. Prevention of ventilator-associated pneumonia with oral antiseptics: a systematic review and meta-analysis. Lancet Infect Dis. 2011 Nov;11(11):845-54. Epub 2011 Jul 26.PubMed PMID: 21798809.