Preintubation Application of Oral Chlorhexidine Does Not Provide Additional Benefit in Prevention of Early-Onset Ventilator-Associated Pneumonia

Abstract

BACKGROUND: Daily application of oral chlorhexidine gluconate (CHX) following intubation to reduce the risk of ventilator-associated pneumonia (VAP) is now the standard of care in many ICUs. Th is randomized clinical trial evaluated the benefi t of adding a preintubation CHX dose to the known benefi t of postintubation CHX to reduce the risk of early-onset VAP. A secondary aim was to test the effect of a preintubation oral application of CHX on early endotracheal tube (ETT) colonization.

The Effect of Ozonated Water and Chlorhexidine Gluconate on Prevention of Ventilator-Associated Pneumonia: A Double-Blind, Randomized, Clinical Trial

“…Munro et al traced the effect of their intervention for 14 days and reported that CHX was effective in preventing VAP infections only up to the 3rd day (26). In the current study, it was observed that CHX had the same effect as ozonated water on the prevention of VAP infections up to the 3rd day.…”

“…Some studies found that CHX was ineffective to prevent VAP infection (13,26). Munro et al traced the effect of their intervention for 14 days and reported that CHX was effective in preventing VAP infections only up to the 3rd day (26).…”

“…However, other studies showed that 0.2% CHX had no toxic effect on oral cells, while the toxic effects of 2% CHX included stimulation of oral mucosa, alterations in the sense of taste, and reversible color change of the mouth, tongue, and teeth (23)(24)(25). Thus, it is clear that there is no general consensus on the appropriate concentration of CHX in standard mouthwashes to prevent VAP (13,26). Indeed, many of the reported results on the effectiveness of CHX for VAP prevention are contradictory.…”

A 2015 Update on Ventilator-Associated Pneumonia: New Insights on Its Prevention, Diagnosis, and Treatment

“…There was no significant benefit on mortality, days of mechanical ventilation or length of ICU stay. A recent RCT by Munro et al used chlorhexidine prior to intubation to determine if this would decrease the rates of VAP compared to patients who were not pre-treated with chlorhexidine before being intubated [57]. All patients subsequently received chlorhexidine twice daily.…”

Prehospital oral chlorhexidine does not reduce the rate of ventilator-associated pneumonia among critically ill trauma patients: A prospective concurrent-control study

“…This study is the third clinical trial to test early administration of oral chlorhexidine to reduce the risk of VAP [25,26] but the first to apply chlorhexidine in the prehospital environment for a very high risk cohort [11]. Considering these trials in aggregate, the only observed difference in clinical outcome was reported in a single trial that attributed efficacy to imbalances in baseline risk for pneumonia-there was not actually a raw difference observed in the primary end point 48 or 72 hours after admission [26].…”