Care of the Critically Ill Early, single chlorhexidine application reduces ventilator-associated pneumonia in trauma patients

abstract Background: Ventilator-associated pneumonia (VAP) is an importantcomplication of mechanical ventilation and is particularly common intrauma, burn, and surgical patients. Interventions that kill bacteria in theoropharynx reduce the pool of viable organisms available for translocationto the lung and thereby lessen the likelihood of developing VAP. Repeatedadministration of chlorhexidine (CHX) to the mouth and oropharynx hasbeen shown to reduce the incidence of VAP, but use of a single dose has notbeen studied. This randomized, controlled clinical trial tested an early(within 12 hours of intubation) application of CHX by swab versus control(no swab) on oral microbial flora and VAP.Methods: A total of 145 trauma patients requiring endotracheal intubation wererandomly assigned to the intervention (5 mL CHX) or control group. VAP (ClinicalPulmonary Infection Score [CPIS] 6) was evaluated on study admission and at48 and 72 hours after intubation.Results: A total of 145 patients were enrolled; 71 and 74 patients wererandomized to intervention and control groups, respectively. Seventypercent of the patients were male, and 60% were white; their mean age was42.4 years (18.2). A significant treatment effect was found on CPIS bothfrom admission to 48 hours (P ¼ .020) and to 72 hours (P ¼ .027). In thosesubjects without pneumonia at baseline (CPIS < 6), 55.6% of the controlpatients (10/18) had developed VAP by 48 or 72 hours versus only 33.3% ofthe intervention patients (7/21).