Duration of action of a single, early oral application of chlorhexidine on oral microbial flora in mechanically ventilated patients: a pilot study

Grap, Mary Jo; Munro, Cindy L.; Elswick, R. K.; Sessler, Curtis N.; Ward, Kevin R.

doi:10.1016/j.hrtlng.2003.12.004

Cited by 113 publications

(94 citation statements)

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“…Oral care regimens that improve oral health status and modulate bacterial overgrowth could reduce the development of nosocomial VAP. [1][2][3][4][11][12][13][14][15] Grap et al 16 investigated the relationship between VAP and oral health status in a sample of 34 adults receiving mechanical ventilation. Alterations in oral health status occurred during the first 7 days after intubation, with microbial colonization of the oropharynx and trachea.…”

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confidence: 99%

Oral Care Interventions and Oropharyngeal Colonization in Children Receiving Mechanical Ventilation

Kusahara

Carvalho

Núñez

et al. 2009

American Journal of Critical Care

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Background Recent progress in identification of oral microorganisms has shown that the oropharynx can be a site of origin for dissemination of pathogenic organisms to distant body sites, such as the lungs. Objective To compare the oropharyngeal microbiological profile, duration of mechanical ventilation, and length of stay in the intensive care unit of children receiving mechanical ven ti lation who had pharmacological or nonpharmacological oral care. Methods A randomized and controlled study was performed in a pediatric intensive unit in São Paulo, Brazil. A total of 56 children were randomly assigned to an experimental group (n = 27, 48%) that received oral care with use of 0.12% chlorhexidine digluconate or a control group (n = 29, 52%) that received oral care without an antiseptic. Oropharyngeal secretions were collected and cultured on days 0, 2, and 4, and at discharge. Results The 2 groups had similar demographic characteristics, preexisting underlying diseases, and pharmacological, nutritional, and ventilatory support. Gram-negative bacteria were the predominant pathogens: Acinetobacter baumannii, Pseudomonas aeruginosa, Klebsiella pneumoniae, and Enterobacter species. The 2 groups did not differ significantly in the colonization of normal (P = .72) or pathogenic (P = .62) flora, in the duration of mechanical ventilation (P = .67), or in length of stay in the intensive care (P = . Notice to CE enrollees:A closed-book, multiple-choice examination following this article tests your under standing of the following objectives:1. Describe the incidence of ventilator-associated pneumonia in the pediatric intensive care unit (PICU) patient population.2. Identify microorganisms that commonly colonize the oropharynx of PICU patients.3. Recognize the impact of an oral care routine using chlorhexidine on a PICU study group.

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confidence: 99%

Oral Care Interventions and Oropharyngeal Colonization in Children Receiving Mechanical Ventilation

Kusahara

Carvalho

Núñez

et al. 2009

American Journal of Critical Care

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“…(16) Analyzing the results obtained, it was observed that, in 3 (60%) of the RCTs, the topical use of chlorhexidine in the oral hygiene of adult patients on mechanical ventilation reduced the incidence of VAP, with statistically significant results. (13,16,23) Although Grap et al (24) found no differences between the experimental and the control groups in terms of incidence of VAP, they considered their study sample small (34 subjects). It should be noted that, in that study, the diagnosis of VAP was determined by a score, based only on clinical and X-ray findings, (26) To evaluate the effect of oral administration of chlorhexidine on the incidence of VAP.…”

Section: Methodsmentioning

confidence: 98%

“…(13,16,(23)(24)(25) Regarding the methodological design, 2 (40%) of the 5 RCTs were double-blind, 1 (20%) was singleblind, and 2 (40%) were not blind. In addition, 4 (80%) involved patients admitted to medical-surgical ICUs, and 1 (20%) involved patients submitted to cardiac surgery.…”

Section: Methodsmentioning

confidence: 99%

“…In only one study, (23) the number of phenolic antiseptic agent and, therefore, has no residual effect like that of chlorhexidine, was used for comparison. However, 2 (40%) of the publications mentioned usual care as a control: in one study, the usual care employed was not described (24) ; and, in the other, an isotonic solution of sodium bicarbonate was used to rinse the oral cavity. (16) Analyzing the results obtained, it was observed that, in 3 (60%) of the RCTs, the topical use of chlorhexidine in the oral hygiene of adult patients on mechanical ventilation reduced the incidence of VAP, with statistically significant results.…”

Section: Methodsmentioning

confidence: 99%

“…Of those, 5 were the RCTs included in our study, (13,16,(23)(24)(25) and the remaining 2 were an unpublished article and an article published before 1998, which is outside the time period established the inclusion criteria of the present review. Due to the heterogeneity of the studies, no statistical significance was found, even though the use of chlorhexidine resulted in a 30% reduction in the relative risk of acquiring VAP.…”

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confidence: 99%

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Higiene bucal com clorexidina na prevenção de pneumonia associada à ventilação mecânica

Beraldo

Andrade

2008

J. bras. pneumol.

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those that favor the colonization of the oropharynx or the stomach, the aspiration of secretions into the lower respiratory tract or reflux of the gastrointestinal tract, and factors inherent in the host. (2,4,5) The bacterial agent found will depend on length of hospital stay, use of antimicrobial agents, host susceptibility, and ICU microbiota. Gram-negative bacilli (Pseudomonas aeruginosa, Proteus spp., Acinetobacter spp.) and Staphylococcus aureus are frequently isolated. (6,7) Considering that the microbiota of the oral cavity represents a threat to critical patients, (2,4,(8)(9)(10)(11)(12) some strate- IntroductionVentilator-associated pneumonia (VAP) is defined as that developing in the period from 48 h after initiation of mechanical ventilation to 48 h after extubation. It is one of the most common cross infections in intensive care units (ICUs), with rates that range from 9 to 40% of the infections acquired in these units, and is associated with an increase in length of hospitalization and in morbidity and mortality rates, which significantly affects costs. (1)(2)(3) The aspiration of microorganisms present in the oropharynx constitutes the most common means of acquiring the disease, and the principal risk factors are AbstractVentilator-associated pneumonia (VAP) is a common infection in intensive care units (ICUs), and oral antiseptic is used as a preventive measure. We reviewed meta-analyses and randomized clinical trials indexed in the Medical Literature Analysis and Retrieval System and Cumulative Index to Nursing and Allied Health Literature databases regarding the topical use of chlorhexidine in the prevention of VAP. Eight publications were analyzed. In seven (87.5%) chlorhexidine diminished the colonization of the oropharynx, and in four (50%) there was a reduction of VAP. Chlorhexidine seems to reduce colonization, thus reducing the incidence of VAP.Keywords: Pneumonia, ventilator-associated; Oral hygiene; Chlorhexidine. ResumoA pneumonia associada à ventilação mecânica (PAVM) é uma infecção freqüente nas unidades de terapia intensiva (UTI), e anti-sépticos bucais são utilizados preventivamente. Revisamos metanálises e ensaios clínicos randomizados indexados no Medical Literature Analysis and Retrieval System e Cumulative Index to Nursing and Allied Health Literature sobre o uso tópico da clorexidina na prevenção da PAVM.Oito publicações foram avaliadas. Em sete (87,5%), a clorexidina diminuiu a colonização da orofaringe, e em quatro (50%) houve redução de PAVM. A clorexidina parece diminuir a colonização, podendo reduzir a incidência da PAVM.Descritores: Pneumonia associada à ventilação mecânica; Higiene bucal; Clorexidina.

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Oral hygiene care for critically ill patients to prevent ventilator-associated pneumonia

Shi

Xie

Wang

et al. 2013

Cochrane Database of Systematic Reviews

191

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Duration of action of a single, early oral application of chlorhexidine on oral microbial flora in mechanically ventilated patients: a pilot study

Cited by 113 publications

References 58 publications

Oral Care Interventions and Oropharyngeal Colonization in Children Receiving Mechanical Ventilation

Oral Care Interventions and Oropharyngeal Colonization in Children Receiving Mechanical Ventilation

Higiene bucal com clorexidina na prevenção de pneumonia associada à ventilação mecânica

Oral hygiene care for critically ill patients to prevent ventilator-associated pneumonia

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