Pobo A, Lisboa T, Rodriguez A, Sole R, Magret M, Trefler S, Gómez F, Rello J.; Chest August 2009 136:433-439; published ahead of print May 29, 2009
Background: Poor oral hygiene is associated with respiratory pathogen colonization and secondary lung infection. The impact of adding electric toothbrushing to oral care in order to reduce VAP incidence is unknown.
Methods: Prospective, simple blind, randomized trial including adults intubated for > 48 h. Controlling for exposure to antibiotic treatment, patients were randomized to oral care/8h with 0.12% chlorhexidine (standard group) or standard oral care plus electric toothbrush (toothbrushing group). VAP was documented by quantitative respiratory cultures. Mechanical ventilation duration, ICU LOS, antibiotic use and ICU mortality were secondary end-points.
Results: The study was terminated after randomizing 147 patients (74 toothbrush group) in a scheduled interim analysis. The two groups were comparable at baseline. The dental brushing group and the 0.12% chlorhexidine digluconate alone group had similar rates of suspected VAP (24.7% in the standard group vs 20.3% in the toothbrushing group, p = 0.55). After adjustment for severity of illness and admission diagnosis, the incidence of microbiologically documented VAP was also similar in the two groups (HR = 0.84 95%CI 0.41-1.73). The groups did not differ significantly in mortality, antibiotic-free days, duration of mechanical ventilation or length of ICU stay.
Conclusions: Our findings suggest that the addition of electric toothbrushing to a standard oral care with 0.12% chlorhexidine digluconate is not effective for the prevention of VAP.
Background: Poor oral hygiene is associated with respiratory pathogen colonization and secondary lung infection. The impact of adding electric toothbrushing to oral care in order to reduce VAP incidence is unknown.
Methods: Prospective, simple blind, randomized trial including adults intubated for > 48 h. Controlling for exposure to antibiotic treatment, patients were randomized to oral care/8h with 0.12% chlorhexidine (standard group) or standard oral care plus electric toothbrush (toothbrushing group). VAP was documented by quantitative respiratory cultures. Mechanical ventilation duration, ICU LOS, antibiotic use and ICU mortality were secondary end-points.
Results: The study was terminated after randomizing 147 patients (74 toothbrush group) in a scheduled interim analysis. The two groups were comparable at baseline. The dental brushing group and the 0.12% chlorhexidine digluconate alone group had similar rates of suspected VAP (24.7% in the standard group vs 20.3% in the toothbrushing group, p = 0.55). After adjustment for severity of illness and admission diagnosis, the incidence of microbiologically documented VAP was also similar in the two groups (HR = 0.84 95%CI 0.41-1.73). The groups did not differ significantly in mortality, antibiotic-free days, duration of mechanical ventilation or length of ICU stay.
Conclusions: Our findings suggest that the addition of electric toothbrushing to a standard oral care with 0.12% chlorhexidine digluconate is not effective for the prevention of VAP.