CHLORHEXIDINE, TOOTHBRUSHING, AND PREVENTING VENTILATOR-ASSOCIATED PNEUMONIA IN CRITICALLY ILL ADULTS
Identifieur interne : 002907 ( Ncbi/Checkpoint ); précédent : 002906; suivant : 002908CHLORHEXIDINE, TOOTHBRUSHING, AND PREVENTING VENTILATOR-ASSOCIATED PNEUMONIA IN CRITICALLY ILL ADULTS
Auteurs : Cindy L. Munro ; Mary Jo Grap ; Deborah J. Jones ; Donna K. Mcclish ; Curtis N. SesslerSource :
- American journal of critical care : an official publication, American Association of Critical-Care Nurses [ 1062-3264 ] ; 2009.
Abstract
Ventilator-associated pneumonia is associated with increased morbidity and mortality.
To examine the effects of mechanical (toothbrushing), pharmacological (topical oral chlorhexidine), and combination (toothbrushing plus chlorhexidine) oral care on the development of ventilator-associated pneumonia in critically ill patients receiving mechanical ventilation.
Critically ill adults in 3 intensive care units were enrolled within 24 hours of intubation in a randomized controlled clinical trial with a 2 × 2 factorial design. Patients with a clinical diagnosis of pneumonia at the time of intubation and edentulous patients were excluded. Patients (n = 547) were randomly assigned to 1 of 4 treatments: 0.12% solution chlorhexidine oral swab twice daily, toothbrushing thrice daily, both toothbrushing and chlorhexidine, or control (usual care). Ventilator-associated pneumonia was determined by using the Clinical Pulmonary Infection Score (CPIS).
The 4 groups did not differ significantly in clinical characteristics. At day 3 analysis, 249 patients remained in the study. Among patients without pneumonia at baseline, pneumonia developed in 24% (CPIS ≥6) by day 3 in those treated with chlorhexidine. When data on all patients were analyzed together, mixed models analysis indicated no effect of either chlorhexidine (
Chlorhexidine, but not toothbrushing, reduced early ventilator-associated pneumonia in patients without pneumonia at baseline.
Url:
DOI: 10.4037/ajcc2009792
PubMed: 19723863
PubMed Central: 3722581
Affiliations:
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Sessler</name></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">19723863</idno><idno type="pmc">3722581</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3722581</idno><idno type="RBID">PMC:3722581</idno><idno type="doi">10.4037/ajcc2009792</idno><date when="2009">2009</date><idno type="wicri:Area/Pmc/Corpus">002768</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">002768</idno><idno type="wicri:Area/Pmc/Curation">002768</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">002768</idno><idno type="wicri:Area/Pmc/Checkpoint">002576</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Checkpoint">002576</idno><idno type="wicri:Area/Ncbi/Merge">002907</idno><idno type="wicri:Area/Ncbi/Curation">002907</idno><idno type="wicri:Area/Ncbi/Checkpoint">002907</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">CHLORHEXIDINE, TOOTHBRUSHING, AND PREVENTING VENTILATOR-ASSOCIATED PNEUMONIA IN CRITICALLY ILL ADULTS</title><author><name sortKey="Munro, Cindy L" sort="Munro, Cindy L" uniqKey="Munro C" first="Cindy L." last="Munro">Cindy L. Munro</name></author><author><name sortKey="Grap, Mary Jo" sort="Grap, Mary Jo" uniqKey="Grap M" first="Mary Jo" last="Grap">Mary Jo Grap</name></author><author><name sortKey="Jones, Deborah J" sort="Jones, Deborah J" uniqKey="Jones D" first="Deborah J." last="Jones">Deborah J. Jones</name></author><author><name sortKey="Mcclish, Donna K" sort="Mcclish, Donna K" uniqKey="Mcclish D" first="Donna K." last="Mcclish">Donna K. Mcclish</name></author><author><name sortKey="Sessler, Curtis N" sort="Sessler, Curtis N" uniqKey="Sessler C" first="Curtis N." last="Sessler">Curtis N. Sessler</name></author></analytic><series><title level="j">American journal of critical care : an official publication, American Association of Critical-Care Nurses</title><idno type="ISSN">1062-3264</idno><idno type="eISSN">1937-710X</idno><imprint><date when="2009">2009</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec id="S1"><title>Background</title><p id="P1">Ventilator-associated pneumonia is associated with increased morbidity and mortality.</p></sec><sec id="S2"><title>Objective</title><p id="P2">To examine the effects of mechanical (toothbrushing), pharmacological (topical oral chlorhexidine), and combination (toothbrushing plus chlorhexidine) oral care on the development of ventilator-associated pneumonia in critically ill patients receiving mechanical ventilation.</p></sec><sec id="S3"><title>Methods</title><p id="P3">Critically ill adults in 3 intensive care units were enrolled within 24 hours of intubation in a randomized controlled clinical trial with a 2 × 2 factorial design. Patients with a clinical diagnosis of pneumonia at the time of intubation and edentulous patients were excluded. Patients (n = 547) were randomly assigned to 1 of 4 treatments: 0.12% solution chlorhexidine oral swab twice daily, toothbrushing thrice daily, both toothbrushing and chlorhexidine, or control (usual care). Ventilator-associated pneumonia was determined by using the Clinical Pulmonary Infection Score (CPIS).</p></sec><sec id="S4"><title>Results</title><p id="P4">The 4 groups did not differ significantly in clinical characteristics. At day 3 analysis, 249 patients remained in the study. Among patients without pneumonia at baseline, pneumonia developed in 24% (CPIS ≥6) by day 3 in those treated with chlorhexidine. When data on all patients were analyzed together, mixed models analysis indicated no effect of either chlorhexidine (<italic>P</italic> = .29) or toothbrushing (<italic>P</italic> = .95). However, chlorhexidine significantly reduced the incidence of pneumonia on day 3 (CPIS ≥6) among patients who had CPIS <6 at baseline (<italic>P</italic> = .006). Toothbrushing had no effect on CPIS and did not enhance the effect of chlorhexidine.</p></sec><sec id="S5"><title>Conclusions</title><p id="P5">Chlorhexidine, but not toothbrushing, reduced early ventilator-associated pneumonia in patients without pneumonia at baseline.</p></sec></div></front></TEI><affiliations><list></list><tree><noCountry><name sortKey="Grap, Mary Jo" sort="Grap, Mary Jo" uniqKey="Grap M" first="Mary Jo" last="Grap">Mary Jo Grap</name><name sortKey="Jones, Deborah J" sort="Jones, Deborah J" uniqKey="Jones D" first="Deborah J." last="Jones">Deborah J. Jones</name><name sortKey="Mcclish, Donna K" sort="Mcclish, Donna K" uniqKey="Mcclish D" first="Donna K." last="Mcclish">Donna K. Mcclish</name><name sortKey="Munro, Cindy L" sort="Munro, Cindy L" uniqKey="Munro C" first="Cindy L." last="Munro">Cindy L. Munro</name><name sortKey="Sessler, Curtis N" sort="Sessler, Curtis N" uniqKey="Sessler C" first="Curtis N." last="Sessler">Curtis N. Sessler</name></noCountry></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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