[Less ventilator-associated pneumonia after oral decontamination with chlorhexidine; a randomised trial]. / Minder beademingspneumonieën door orale decontaminatie met chloorhexidine; gerandomiseerde trial.
Ned Tijdschr Geneeskd
; 152(13): 752-9, 2008 Mar 29.
Article
em Nl
| MEDLINE
| ID: mdl-18461894
ABSTRACT
OBJECTIVE:
To determine the effect of oral decontamination with either chlorhexidine (CHX, 2%) or the combination chlorhexidine-colistin (CHX-COL, 2%-2%) on the frequency and the time to onset of ventilator-associated pneumonia in Intensive Care patients.DESIGN:
Double blind, placebo-controlled, multicentre, randomised trial.METHODS:
Consecutive ICU patients needing at least 48 h of mechanical ventilation were enrolled in a randomized trial with 3 arms CHX, CHX-COL, and placebo (PLAC). The trial medication was administered in the oral cavity every 6 h. Oropharyngeal swabs were obtained daily and analysed quantitatively for Gram-positive and Gram-negative microorganisms. Endotracheal colonisation was monitored twice weekly. Ventilator-associated pneumonia was diagnosed on the basis of a combination of clinical, radiological and microbiological criteria.RESULTS:
Of 385 patients included, 130 received PLAC, 127 CHX and 128 CHX-COL. Baseline characteristics in the three groups were comparable. The daily risk of ventilator-associated pneumonia was reduced in both treatment groups compared to PLAC 65% (HR= 0.352; 95% CI 0.160-0.791; p = 0.012) for CHX and 55% (HR= 0.454; 95%/ CI 0.224-0.925; p = 0.030) for CHX-COL. CHX-COL provided a significant reduction in oropharyngeal colonisation with both Gram-negative and Gram-positive microorganisms, whereas CHX significantly affected only colonisation with Gram-positive microorganisms. There were no differences in the duration of mechanical ventilation, ICU-stay or ICU-survival.CONCLUSION:
Oral decontamination of the oropharyngeal cavity with chlorhexidine or the combination chlorhexidine-colistin reduced the incidence and the time to onset ofventilator-associated pneumonia.
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Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Ventiladores Mecânicos
/
Clorexidina
/
Pneumonia Bacteriana
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Anti-Infecciosos Locais
/
Boca
Tipo de estudo:
Clinical_trials
/
Risk_factors_studies
Limite:
Adult
/
Female
/
Humans
/
Male
/
Middle aged
Idioma:
Nl
Revista:
Ned Tijdschr Geneeskd
Ano de publicação:
2008
Tipo de documento:
Article