Early, single chlorhexidine application reduces ventilator-associated pneumonia in trauma patients

Mary Jo Grap, Cindy Munro, V. Anne Hamilton, R. K. Elswick, Curtis N. Sessler, Kevin R. Ward

Research output: Contribution to journalArticle

39 Citations (Scopus)

Abstract

Background: Ventilator-associated pneumonia (VAP) is an important complication of mechanical ventilation and is particularly common in trauma, burn, and surgical patients. Interventions that kill bacteria in the oropharynx reduce the pool of viable organisms available for translocation to the lung and thereby lessen the likelihood of developing VAP. Repeated administration of chlorhexidine (CHX) to the mouth and oropharynx has been shown to reduce the incidence of VAP, but use of a single dose has not been studied. This randomized, controlled clinical trial tested an early (within 12 hours of intubation) application of CHX by swab versus control (no swab) on oral microbial flora and VAP. Methods: A total of 145 trauma patients requiring endotracheal intubation were randomly assigned to the intervention (5 mL CHX) or control group. VAP (Clinical Pulmonary Infection Score [CPIS] ≥ 6) was evaluated on study admission and at 48 and 72 hours after intubation. Results: A total of 145 patients were enrolled; 71 and 74 patients were randomized to intervention and control groups, respectively. Seventy percent of the patients were male, and 60% were white; their mean age was 42.4 years (±18.2). A significant treatment effect was found on CPIS both from admission to 48 hours (P = .020) and to 72 hours (P = .027). In those subjects without pneumonia at baseline (CPIS < 6), 55.6% of the control patients (10/18) had developed VAP by 48 or 72 hours versus only 33.3% of the intervention patients (7/21). Conclusion: an early, single application of CHX to the oral cavity significantly reduces CPIS and thus VAP in trauma patients.

Original languageEnglish (US)
JournalHeart and Lung: Journal of Acute and Critical Care
Volume40
Issue number5
DOIs
StatePublished - Sep 1 2011
Externally publishedYes

Fingerprint

Ventilator-Associated Pneumonia
Chlorhexidine
Wounds and Injuries
Lung
Oropharynx
Infection
Intubation
Mouth
Control Groups
Intratracheal Intubation
Artificial Respiration
Pneumonia
Randomized Controlled Trials
Bacteria
Incidence

Keywords

  • Chlorhexidine
  • Oral care
  • Ventilator-associated pneumonia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Critical Care and Intensive Care Medicine
  • Pulmonary and Respiratory Medicine

Cite this

Early, single chlorhexidine application reduces ventilator-associated pneumonia in trauma patients. / Grap, Mary Jo; Munro, Cindy; Hamilton, V. Anne; Elswick, R. K.; Sessler, Curtis N.; Ward, Kevin R.

In: Heart and Lung: Journal of Acute and Critical Care, Vol. 40, No. 5, 01.09.2011.

Research output: Contribution to journalArticle

Grap, Mary Jo ; Munro, Cindy ; Hamilton, V. Anne ; Elswick, R. K. ; Sessler, Curtis N. ; Ward, Kevin R. / Early, single chlorhexidine application reduces ventilator-associated pneumonia in trauma patients. In: Heart and Lung: Journal of Acute and Critical Care. 2011 ; Vol. 40, No. 5.
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abstract = "Background: Ventilator-associated pneumonia (VAP) is an important complication of mechanical ventilation and is particularly common in trauma, burn, and surgical patients. Interventions that kill bacteria in the oropharynx reduce the pool of viable organisms available for translocation to the lung and thereby lessen the likelihood of developing VAP. Repeated administration of chlorhexidine (CHX) to the mouth and oropharynx has been shown to reduce the incidence of VAP, but use of a single dose has not been studied. This randomized, controlled clinical trial tested an early (within 12 hours of intubation) application of CHX by swab versus control (no swab) on oral microbial flora and VAP. Methods: A total of 145 trauma patients requiring endotracheal intubation were randomly assigned to the intervention (5 mL CHX) or control group. VAP (Clinical Pulmonary Infection Score [CPIS] ≥ 6) was evaluated on study admission and at 48 and 72 hours after intubation. Results: A total of 145 patients were enrolled; 71 and 74 patients were randomized to intervention and control groups, respectively. Seventy percent of the patients were male, and 60{\%} were white; their mean age was 42.4 years (±18.2). A significant treatment effect was found on CPIS both from admission to 48 hours (P = .020) and to 72 hours (P = .027). In those subjects without pneumonia at baseline (CPIS < 6), 55.6{\%} of the control patients (10/18) had developed VAP by 48 or 72 hours versus only 33.3{\%} of the intervention patients (7/21). Conclusion: an early, single application of CHX to the oral cavity significantly reduces CPIS and thus VAP in trauma patients.",
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