Pre-Intubation application of oral chlorhexidine does not provide additional benefit in prevention of early onset ventilator-associated pneumonia.
Chest. 2014 Oct 9;
Authors: Munro CL, Grap MJ, Sessler CN, Elswick RK, Mangar D, Karlnoski-Everall R, Cairns P
Abstract
Abstract: IntroductionDaily application of oral chlorhexidine gluconate (CHX) following intubation to reduce risk of ventilator-associated pneumonia (VAP) is now standard of care in many intensive care units. This randomized clinical trial evaluated the benefit of adding a pre-intubation CHX dose to the known benefit of post-intubation CHX to reduce risk of early onset VAP. A secondary aim was to test the effect of a pre-intubation oral application of CHX on early endotracheal tube (ETT) colonization. MethodsSubjects (n=314) were recruited from two teaching hospitals and randomly assigned to oral application of 5 ml CHX 0.12% solution pre-intubation (intervention group, n=157), or to a control group (n=157) who received no CHX pre-intubation. All subjects received CHX twice daily 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, ETT were cultured at extubation. ResultsApplication of a pre-intubation 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 less than 20% in both groups (no statistically significant difference). Mean CPIS remained below 6 (VAP threshold score) in both groups. ConclusionsAlthough it is feasible to deliver CHX prior to intubation (including emergent or urgent intubation), the results suggest that pre-intubation CHX may be inconsequential when the ventilator bundle, including daily oral CHX, is in place. During the pre-intubation period, providers should focus their attention on other critical activities.Clinical Trial Registration:ClinicalTrials.gov NCT00893763.
Introduction: Daily application of oral chlorhexidine gluconate (CHX) following intubation to reduce risk of ventilator-associated pneumonia (VAP) is now standard of care in many intensive care units. This randomized clinical trial evaluated the benefit of adding a pre-intubation CHX dose to the known benefit of post-intubation CHX to reduce risk of early onset VAP. A secondary aim was to test the effect of a pre-intubation oral application of CHX on early endotracheal tube (ETT) colonization.
Methods: Subjects (n=314) were recruited from two teaching hospitals and randomly assigned to oral application of 5 ml CHX 0.12% solution pre-intubation (intervention group, n=157), or to a control group (n=157) who received no CHX pre-intubation. All subjects received CHX twice daily 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, ETT were cultured at extubation.
Results: Application of a pre-intubation 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 less than 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 pre-intubation CHX may be inconsequential when the ventilator bundle, including daily oral CHX, is in place. During the pre-intubation period, providers should focus their attention on other critical activities. Clinical Trial Registration:ClinicalTrials.gov NCT00893763.
Clinical Trial Registration: ClinicalTrials.gov NCT00893763.
PMID: 25317722 [PubMed - as supplied by publisher]