Oral Decontamination with Chlorhexidine Reduces the Incidence of Ventilator-associated Pneumonia

Koeman, Mirelle; Ven, A.J.A.M. van der; Hak, Eelko; Joore, Hans C. A.; Kaasjager, Karin; Smet, Anne Marie G. A. de; Ramsay, Graham; Dormans, Tom; Aarts, Leon; Bel, E E de; Hustinx, W N M; Tweel, Ingeborg van der; Hoepelman, Andy M.; Bonten, Marc J. M.

doi:10.1164/rccm.200505-820oc

Cited by 357 publications

(289 citation statements)

References 57 publications

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“…Chlorhexidine at varying concentrations, however, has been evaluated in more than 11 trials. Impacts on VAP rates have been variable: three reported decreases [64][65][66] while the other eight did not [67][68][69][70][71][72][73][74]. One trial reported a decrease in antibiotic usage for patients treated with chlorhexidine [67].…”

Section: Oral Antiseptics and Antibioticsmentioning

confidence: 99%

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Prevention of ventilator-associated pneumonia

Klompas¹

2010

Expert Review of Anti-infective Therapy

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Section: Oral Antiseptics and Antibioticsmentioning

confidence: 99%

“…Subgroup ana lysis of chlorhexidine trials suggest that it has less activity against Gram-negatives compared with Gram-positives [70,74]. This may be due to a differential effect of the antiseptic or it may suggest an unaddressed reservoir of bacteria in the stomach and GI tract where Gram-negatives predominate.…”

Section: Reviewmentioning

confidence: 99%

Prevention of ventilator-associated pneumonia

Klompas¹

2010

Expert Review of Anti-infective Therapy

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“…(Masterton et al, 2008) Many participants seemed to confuse the oral component of SDD with routine mouthcare using chlorhexidine. The reference was not to selective oral decontamination (SOD), which is the administration of oral antimicrobials and omitting the intestinal and parenteral components, important to differentiate chlorhexidine as an antiseptic (Koeman et al, 2006, Labeau et al, 2011) from the use of topical, non-absorbable antibiotics that feature as a component of SDD. The primary concern for delivering SDD to critically ill patients was the potential for development of antibiotic resistance.…”

Section: Discussionmentioning

confidence: 99%

Implementing selective digestive tract decontamination in the intensive care unit: A qualitative analysis of nurse-identified considerations

et al. 2014

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“…Decontamination with antibiotics reduces the incidence of VAP [11], but it is not currently recommended because of concern for possible selection of resistant bacteria. Oropharyngeal rinse with chlorhexidine was shown to be eff ective in reducing tracheal colonization and VAP incidence in a randomized, placebo-controlled study on nearly 400 patients [12], and is now widely used as standard of care for the intubated patient.…”

Section: Oral Carementioning

confidence: 99%

Novel Preventive Strategies for Ventilator-associated Pneumonia

Coppadoro¹,

Bittner²

2012

Annual Update in Intensive Care and Emergency Medicine 2012

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Ventilator-associated pneumonia (VAP) is a complication of mechanical ventilation and is defi ned as the occurrence of pneumonia in patients undergoing mechanical ventilation for at least 48 hours. Clinical suspicion of VAP arises when new infi ltrates are present on chest x-ray, and at least one of the following is present: Fever, leukocytosis, or purulent tracheo-bronchial secretions.Th e incidence of VAP reported in the literature ranges from 15 to 20% [1]. However, the real incidence of VAP is diffi cult to assess, given the extreme variability of the diagnostic criteria for pneumonia, which often rely on broncho scopic procedures. Th e specifi c mortality attribu table to VAP is also debated. Th e reported VAPassociated mortality ranges from 20 to 70%. Patients with VAP are often critically ill, and survival may be aff ected both by underlying conditions and the new-onset VAP. A recent study demonstrated a relatively limited attributable intensive care unit (ICU)-mortality of VAP, about 1-1.5%, when adjusting for severity of co-existing diseases [2]. In the last few years, various strategies have been investigated in order to reduce the incidence of VAP. Reducing the duration of intubation, oral and endotracheal tube (ETT) care, positioning, and ETT modifi cations are aspects that may have a role in the prevention of VAP. Many of these strategies have been incorporated into 'VAP bundles' , a set of treatments implemented simultaneously to reduce VAP incidence. Recent studies suggest that the use of bundle treatments can result in substantial reductions in rates of VAP [3].In this chapter, we will present some novel VAP prevention strategies, explaining the possible mechanisms by which they may be clinically benefi cial in reducing the incidence of VAP. A summary of these novel strategies is given in Table 1. Reduce duration of intubationTh e risk of developing VAP increases with prolonged intu bation, and reintubation is a known risk factor [4]. Th is fact suggests that the presence of the ETT, although necessary for the survival of the patient, interferes with the normal physiological mechanisms that maintain the airways free of bacterial contamination. When the ETT is in place, the cough refl ex is impaired and normal mucociliary fl ow is blocked by the infl ated cuff . Th e ETT itself allows bacteria to drain into the trachea and distal airways leading to pneumonia. Intubated patients may be more prone to develop VAP as compared to tracheostomized patients because the ETT keeps the trachea and the oropharynx in communication, acting as a bridge for bacteria to move toward the dependent airways. Aspiration of pathogens from the oropharynx in patients with subglottic dysfunction may occur both during extubation and reintubation. Th e rate of reintubation can be reduced by a variety of measures, including avoiding accidental removal of the ETT, improving planned extubations with weaning protocols designed to improve extubation success, and use of non-invasive ventilation (NIV).On the basis of the observatio...

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Oral Decontamination with Chlorhexidine Reduces the Incidence of Ventilator-associated Pneumonia

Abstract: Topical oral decontamination with CHX or CHX/COL reduces the incidence of VAP.

Cited by 357 publications

References 57 publications

Prevention of ventilator-associated pneumonia

Prevention of ventilator-associated pneumonia

Implementing selective digestive tract decontamination in the intensive care unit: A qualitative analysis of nurse-identified considerations

Novel Preventive Strategies for Ventilator-associated Pneumonia

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