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Original Research: CRITICAL CARE MEDICINE |

A Randomized Trial of Dental Brushing for Preventing Ventilator-Associated Pneumonia

Angel Pobo, MD; Thiago Lisboa, MD; Alejandro Rodriguez, MD, PhD; Ramiro Sole, MD; Mónica Magret, MD; Sandra Trefler, BS; Frederic Gómez, MD; Jordi Rello, MD, PhD; for the RASPALL Study Investigators
Author and Funding Information

From the Critical Care Department (Drs. Pobo, Lisboa, Rodriguez, Magret, and Rello, and Ms. Trefler), Centro de Investigacíon Biomedica en Red Enfermedades Respiratorias; Dentistry Care Department (Dr. Sole); and Microbiology Department (Dr. Gómez), Joan XXIII University Hospital, University Rovira i Virgili, Tarragona, Spain.

Jordi Rello, MD, PhD, Critical Care Department, Joan XXIII University Hospital, Carrer Dr. Mallafre Guasch 4, 43007 Tarragona, Spain; e-mail: jrello.hj23.ics@gencat.cat

*A complete list of the RASPALL Study Investigators Steering Committee is located in the Appendix.


This work was supported by Fondo de Investigaciones Sanitarias (FISS 06/060), Centro de Investigacíon Biomedica en Red Enfermedades Respiratorias (06/06/36), and the Agency for the Administration of University and Research Grants (2005/SGR/920).

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/site/misc/reprints.xhtml).


© 2009 American College of Chest Physicians


Chest. 2009;136(2):433-439. doi:10.1378/chest.09-0706
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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 ventilator-associated pneumonia (VAP) incidence is unknown.

Methods:  The study design was a prospective, simple-blind, randomized trial of adult patients intubated for > 48 h. Controlling for exposure to antibiotic treatment, patients were randomized to oral care every 8 h with 0.12% chlorhexidine digluconate (standard group) or standard oral care plus electric toothbrushing (toothbrush group). VAP was documented by quantitative respiratory cultures. Mechanical ventilation (MV) duration, hospital ICU length of stay (LOS), antibiotic use, and hospital 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 toothbrush group and standard group had similar rates of suspected VAP (20.3% vs 24.7%; 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 (hazard ratio, 0.84; 95% confidence interval, 0.41 to 1.73). The groups did not differ significantly in mortality, antibiotic-free days, duration of MV, or hospital ICU LOS.

Conclusions:  Our findings suggest that the addition of electric toothbrushing to standard oral care with 0.12% chlorhexidine digluconate is not effective for the prevention of VAP.

Trial registration:  ClinicalTrials.gov Identifier: NCT00842478

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