PURPOSE: Aspiration of oropharyngeal bacteria is an important step in the pathogenesis of nosocomial pneumonia. Oral cleansing with chlorhexidine decreases the incidence of nosocomial pneumonia in post-cardiac surgery patients but evidence of its benefit in intensive care unit (ICU) patients is conflicting. We therefore studied effect of oral cleansing with 0.2% chlorhexidine gluconate solution on the incidence of pneumonia in ICU patients.
METHODS: 512 patients expected to stay in the ICU for >48 hours were included in this open-label randomized controlled trial. Patients were randomized to twice daily oropharyngeal cleansing with 0.2% chlorhexidine gluconate (n=250) or 0.01% potassium permanganate (n=262; control group). The primary outcome measure was development of nosocomial pneumonia during ICU stay. Potassium permanganate was used as control because it is a very weak antiseptic (1/100th the efficacy of chlorhexidine) and was the standard solution used in the ICU for oral care.
RESULTS: 26 patients in the chlorhexidine group and 15 in the control group were excluded from analysis because of ICU stay <48 hours or incomplete oral cleansing; thus, 471 patients were analyzed (Table 1). Subgroup analysis revealed no significant difference in the primary and secondary outcomes in patients receiving mechanical ventilation, with tracheal intubation and coma (GCS <8) except for shorter length of ICU stay in patients in the chlorhexidine group in the subgroup of mechanically ventilated (p=0.05) and tracheally intubated (p = 0.04) patients.
CONCLUSION: Oral cleansing with 0.2% chlorhexidine failed to reduce the incidence of nosocomial pneumonia in ICU patients.
CLINICAL IMPLICATIONS: Oropharyngeal care with higher concentrations (> 0.2%) of chlorhexidine gluconate in greater frequency (> twice daily) may prove to be useful in the prevention of nosocomial pneumonia.
DISCLOSURE: Tanmay Panchabhai, No Financial Disclosure Information; No Product/Research Disclosure Information