Preintubation application of oral chlorhexidine does not provide additional benefit in prevention of early-onset ventilator-associated pneumonia

Cindy Munro, Mary Jo Grap, Curtis N. Sessler, Ronald K. Elswick, Devanand Mangar, Rachel Karlnoski-Everall, Paula Cairns

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

BACKGROUND: Daily application of oral chlorhexidine gluconate (CHX) following intubation to reduce the risk of ventilator-associated pneumonia (VAP) is now the standard of care in many ICUs. This randomized clinical trial evaluated the benefit of adding a preintubation CHX dose to the known benefit of postintubation CHX to reduce the risk of early-onset VAP. A secondary aim was to test the effect of a preintubation oral application of CHX on early endotracheal tube (ETT) colonization. METHODS: Subjects (N 5 314) were recruited from two teaching hospitals and were randomly assigned to oral application of 5 mL CHX 0.12% solution before intubation (intervention group, n 5 157), or to a control group (n 5 157) who received no CHX before intubation. All subjects received CHX bid after intubation. Groups were compared using a repeated-measures model with Clinical Pulmonary Infection Score (CPIS) as the response variable. In a planned subset of subjects, ETTs were cultured at extubation. RESULTS: Application of a preintubation dose of CHX did not provide benefit over the intervention period beyond that afforded by daily oral CHX following intubation. ETT colonization at extubation was, 20% in both groups (no statistically significant difference). Mean CPIS remained below 6 (VAP threshold score) in both groups. CONCLUSIONS: Although it is feasible to deliver CHX prior to intubation (including emergent or urgent intubation), the results suggest that preintubation CHX may be inconsequential when the ventilator bundle, including daily oral CHX, is in place. During the preintubation period, providers should focus their attention on other critical activities.

Original languageEnglish (US)
Pages (from-to)328-334
Number of pages7
JournalChest
Volume147
Issue number2
DOIs
StatePublished - Feb 1 2015
Externally publishedYes

Fingerprint

Ventilator-Associated Pneumonia
Chlorhexidine
Intubation
chlorhexidine gluconate
Lung
Mechanical Ventilators
Standard of Care
Infection
Teaching Hospitals
Randomized Controlled Trials

ASJC Scopus subject areas

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

Cite this

Preintubation application of oral chlorhexidine does not provide additional benefit in prevention of early-onset ventilator-associated pneumonia. / Munro, Cindy; Grap, Mary Jo; Sessler, Curtis N.; Elswick, Ronald K.; Mangar, Devanand; Karlnoski-Everall, Rachel; Cairns, Paula.

In: Chest, Vol. 147, No. 2, 01.02.2015, p. 328-334.

Research output: Contribution to journalArticle

Munro, Cindy ; Grap, Mary Jo ; Sessler, Curtis N. ; Elswick, Ronald K. ; Mangar, Devanand ; Karlnoski-Everall, Rachel ; Cairns, Paula. / Preintubation application of oral chlorhexidine does not provide additional benefit in prevention of early-onset ventilator-associated pneumonia. In: Chest. 2015 ; Vol. 147, No. 2. pp. 328-334.
@article{f02ab94e9a11426dbccb886d533df3fa,
title = "Preintubation application of oral chlorhexidine does not provide additional benefit in prevention of early-onset ventilator-associated pneumonia",
abstract = "BACKGROUND: Daily application of oral chlorhexidine gluconate (CHX) following intubation to reduce the risk of ventilator-associated pneumonia (VAP) is now the standard of care in many ICUs. This randomized clinical trial evaluated the benefit of adding a preintubation CHX dose to the known benefit of postintubation CHX to reduce the risk of early-onset VAP. A secondary aim was to test the effect of a preintubation oral application of CHX on early endotracheal tube (ETT) colonization. METHODS: Subjects (N 5 314) were recruited from two teaching hospitals and were randomly assigned to oral application of 5 mL CHX 0.12{\%} solution before intubation (intervention group, n 5 157), or to a control group (n 5 157) who received no CHX before intubation. All subjects received CHX bid after intubation. Groups were compared using a repeated-measures model with Clinical Pulmonary Infection Score (CPIS) as the response variable. In a planned subset of subjects, ETTs were cultured at extubation. RESULTS: Application of a preintubation dose of CHX did not provide benefit over the intervention period beyond that afforded by daily oral CHX following intubation. ETT colonization at extubation was, 20{\%} in both groups (no statistically significant difference). Mean CPIS remained below 6 (VAP threshold score) in both groups. CONCLUSIONS: Although it is feasible to deliver CHX prior to intubation (including emergent or urgent intubation), the results suggest that preintubation CHX may be inconsequential when the ventilator bundle, including daily oral CHX, is in place. During the preintubation period, providers should focus their attention on other critical activities.",
author = "Cindy Munro and Grap, {Mary Jo} and Sessler, {Curtis N.} and Elswick, {Ronald K.} and Devanand Mangar and Rachel Karlnoski-Everall and Paula Cairns",
year = "2015",
month = "2",
day = "1",
doi = "10.1378/chest.14-0692",
language = "English (US)",
volume = "147",
pages = "328--334",
journal = "Chest",
issn = "0012-3692",
publisher = "American College of Chest Physicians",
number = "2",

}

TY - JOUR

T1 - Preintubation application of oral chlorhexidine does not provide additional benefit in prevention of early-onset ventilator-associated pneumonia

AU - Munro, Cindy

AU - Grap, Mary Jo

AU - Sessler, Curtis N.

AU - Elswick, Ronald K.

AU - Mangar, Devanand

AU - Karlnoski-Everall, Rachel

AU - Cairns, Paula

PY - 2015/2/1

Y1 - 2015/2/1

N2 - BACKGROUND: Daily application of oral chlorhexidine gluconate (CHX) following intubation to reduce the risk of ventilator-associated pneumonia (VAP) is now the standard of care in many ICUs. This randomized clinical trial evaluated the benefit of adding a preintubation CHX dose to the known benefit of postintubation CHX to reduce the risk of early-onset VAP. A secondary aim was to test the effect of a preintubation oral application of CHX on early endotracheal tube (ETT) colonization. METHODS: Subjects (N 5 314) were recruited from two teaching hospitals and were randomly assigned to oral application of 5 mL CHX 0.12% solution before intubation (intervention group, n 5 157), or to a control group (n 5 157) who received no CHX before intubation. All subjects received CHX bid after intubation. Groups were compared using a repeated-measures model with Clinical Pulmonary Infection Score (CPIS) as the response variable. In a planned subset of subjects, ETTs were cultured at extubation. RESULTS: Application of a preintubation dose of CHX did not provide benefit over the intervention period beyond that afforded by daily oral CHX following intubation. ETT colonization at extubation was, 20% in both groups (no statistically significant difference). Mean CPIS remained below 6 (VAP threshold score) in both groups. CONCLUSIONS: Although it is feasible to deliver CHX prior to intubation (including emergent or urgent intubation), the results suggest that preintubation CHX may be inconsequential when the ventilator bundle, including daily oral CHX, is in place. During the preintubation period, providers should focus their attention on other critical activities.

AB - BACKGROUND: Daily application of oral chlorhexidine gluconate (CHX) following intubation to reduce the risk of ventilator-associated pneumonia (VAP) is now the standard of care in many ICUs. This randomized clinical trial evaluated the benefit of adding a preintubation CHX dose to the known benefit of postintubation CHX to reduce the risk of early-onset VAP. A secondary aim was to test the effect of a preintubation oral application of CHX on early endotracheal tube (ETT) colonization. METHODS: Subjects (N 5 314) were recruited from two teaching hospitals and were randomly assigned to oral application of 5 mL CHX 0.12% solution before intubation (intervention group, n 5 157), or to a control group (n 5 157) who received no CHX before intubation. All subjects received CHX bid after intubation. Groups were compared using a repeated-measures model with Clinical Pulmonary Infection Score (CPIS) as the response variable. In a planned subset of subjects, ETTs were cultured at extubation. RESULTS: Application of a preintubation dose of CHX did not provide benefit over the intervention period beyond that afforded by daily oral CHX following intubation. ETT colonization at extubation was, 20% in both groups (no statistically significant difference). Mean CPIS remained below 6 (VAP threshold score) in both groups. CONCLUSIONS: Although it is feasible to deliver CHX prior to intubation (including emergent or urgent intubation), the results suggest that preintubation CHX may be inconsequential when the ventilator bundle, including daily oral CHX, is in place. During the preintubation period, providers should focus their attention on other critical activities.

UR - http://www.scopus.com/inward/record.url?scp=84928338440&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84928338440&partnerID=8YFLogxK

U2 - 10.1378/chest.14-0692

DO - 10.1378/chest.14-0692

M3 - Article

VL - 147

SP - 328

EP - 334

JO - Chest

JF - Chest

SN - 0012-3692

IS - 2

ER -