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Original Research: Critical Care |

Preintubation Application of Oral Chlorhexidine Does Not Provide Additional Benefit in Prevention of Early-Onset Ventilator-Associated PneumoniaPreintubation Oral Chlorhexidine

Cindy L. Munro, PhD, RN, ANP; Mary Jo Grap, PhD, RN; Curtis N. Sessler, MD, FCCP; Ronald K. Elswick, Jr, PhD; Devanand Mangar, MD; Rachel Karlnoski-Everall, PhD; Paula Cairns, BSN, RN
Author and Funding Information

From the University of South Florida (Dr Munro and Ms Cairns), Tampa, FL; Virginia Commonwealth University (Drs Grap, Sessler, and Elswick), Richmond, VA; and Tampa General Hospital and Florida Gulf to Bay Anesthesiology (Drs Mangar and Karlnoski-Everall), Tampa, FL.

CORRESPONDENCE TO: Cindy L. Munro, PhD, RN, ANP, University of South Florida College of Nursing, 12901 Bruce B. Downs Blvd, MDC22, Tampa, FL 33612-4766; e-mail: cmunro2@health.usf.edu


FUNDING/SUPPORT: This study was supported by the National Institutes of Health National Institute of Nursing Research [Grant R01 NR07652].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2015;147(2):328-334. doi:10.1378/chest.14-0692
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BACKGROUND:  Daily application of oral chlorhexidine gluconate (CHX) following intubation to reduce the risk of ventilator-associated pneumonia (VAP) is now the standard of care in many ICUs. This randomized clinical trial evaluated the benefit of adding a preintubation CHX dose to the known benefit of postintubation CHX to reduce the risk of early-onset VAP. A secondary aim was to test the effect of a preintubation oral application of CHX on early endotracheal tube (ETT) colonization.

METHODS:  Subjects (N = 314) were recruited from two teaching hospitals and were randomly assigned to oral application of 5 mL CHX 0.12% solution before intubation (intervention group, n = 157), or to a control group (n = 157) who received no CHX before intubation. All subjects received CHX bid after intubation. Groups were compared using a repeated-measures model with Clinical Pulmonary Infection Score (CPIS) as the response variable. In a planned subset of subjects, ETTs were cultured at extubation.

RESULTS:  Application of a preintubation dose of CHX did not provide benefit over the intervention period beyond that afforded by daily oral CHX following intubation. ETT colonization at extubation was < 20% in both groups (no statistically significant difference). Mean CPIS remained below 6 (VAP threshold score) in both groups.

CONCLUSIONS:  Although it is feasible to deliver CHX prior to intubation (including emergent or urgent intubation), the results suggest that preintubation CHX may be inconsequential when the ventilator bundle, including daily oral CHX, is in place. During the preintubation period, providers should focus their attention on other critical activities.

TRIAL REGISTRY:  ClinicalTrials.gov; No.: NCT00893763; URL: www.clinicaltrials.gov

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