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Randomized Controlled Trial
. 2017 Jan 31;17(1):112.
doi: 10.1186/s12879-017-2188-0.

Impact of oral hygiene involving toothbrushing versus chlorhexidine in the prevention of ventilator-associated pneumonia: a randomized study

Claudia Fernanda de Lacerda Vidal  1 , Aurora Karla de Lacerda Vidal  2 , José Gildo de Moura Monteiro Jr  3 , Aracele Cavalcanti  4 , Ana Paula da Costa Henriques  5 , Márcia Oliveira  6 , Michele Godoy  7 , Mirella Coutinho  7 , Pollyanna Dutra Sobral  7 , Claudia Ângela Vilela  7 , Bárbara Gomes  7 , Marta Amorim Leandro  8 , Ulisses Montarroyos  9 , Ricardo de Alencar Ximenes  10 , Heloísa Ramos Lacerda  11
Affiliations
Randomized Controlled Trial

Impact of oral hygiene involving toothbrushing versus chlorhexidine in the prevention of ventilator-associated pneumonia: a randomized study

Claudia Fernanda de Lacerda Vidal et al. BMC Infect Dis. .

Erratum in

Abstract

Background: Nosocomial pneumonia has correlated to dental plaque and to oropharynx colonization in patients receiving mechanical ventilation. The interruption of this process, by preventing colonization of pathogenic bacteria, represents a potential procedure for the prevention of ventilator-associated pneumonia (VAP).

Methods: The study design was a prospective, randomized trial to verify if oral hygiene through toothbrushing plus chlorhexidine in gel at 0.12% reduces the incidence of ventilatior-associated pneumonia, the duration of mechanical ventilation, the length of hospital stay and the mortality rate in ICUs, when compared to oral hygiene only with chlorhexidine, solution of 0.12%, without toothbrushing, in adult individuals under mechanical ventilation, hospitalized in Clinical/Surgical and Cardiology Intensive Care Units (ICU). The study protocol was approved by the Ethical Committee of Research of the Health Sciences Center of the Federal University of Pernambuco - Certificate of Ethical Committee Approval (CAAE) 04300012500005208. Because it was a randomized trial, the research used CONSORT 2010 checklist criteria.

Results: Seven hundred sixteen patients were admitted into the ICU; 219 fulfilled the criteria for inclusion and 213 patients were included; 108 were randomized to control group and 105 to intervention group. Toothbrushing plus 0.12% chlorhexidine gel demonstrated a lower incidence of VAP throughout the follow up period, although the difference was not statistically significant (p = 0.084). There was a significant reduction of the mean time of mechanical ventilation in the toothbrushing group (p = 0.018). Regarding the length of hospital stay in the ICU and mortality rates, the difference was not statistically significant (p = 0.064).

Conclusions: The results obtained showed that, among patients undergoing toothbrushing there was a significant reduction in duration of mechanical ventilation, and a tendency to reduce the incidence of VAP and length of ICU stay, although without statistical significance.

Trial registration: Retrospectively registered in the Brazilian Clinical Trials Registry (Registro Brasileiro de Ensaios Clínicos) - RBR-4TWH4M (4 September 2016).

Keywords: Chlorhexidine; Intensive care; Mechanical ventilator; Oral hygiene; Pneumonia; Toothbrushing.

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Figures

Fig. 1
Fig. 1
Diagram of patient inclusion in the study. Extubated <48 h = patients with mechanical ventilation expectancy longer than 48 h but extubated in the first 48 h extubation. End of cohort = patients with no definite outcome at the end of the study period
See this image and copyright information in PMC

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