Effect of oropharyngeal decontamination by povidone-iodine on ventilator-associated pneumonia in patients with head trauma.
OBJECTIVE
To evaluate the effect of a regular oropharyngeal application of povidone-iodine on the prevalence of ventilator-associated pneumonia in patients with severe head trauma.


METHODS
Prospective randomized study.


METHODS
A surgical intensive care unit of a university hospital.


METHODS
Patients with severe head trauma (Glasgow Coma Score of < or =8) expected to need ventilation for > or =2 days were prospectively randomized into three groups: those receiving nasopharynx and oropharynx rinsing with 20 mL of a 10% povidone-iodine aqueous solution, reconstituted in a 60-mL solution with sterile water (povidone-iodine group); those receiving nasopharynx and oropharynx rinsing with 60 mL of saline solution (saline group); or those undergoing a standard regimen without any instillation but with aspiration of oropharyngeal secretions (control group).


RESULTS
The prevalence of ventilator-associated pneumonia was compared among the three groups. A total of 98 patients were analyzed (povidone-iodine group, n = 36; saline group, n = 31; and control group, n = 31). A total of 28 cases of ventilator-associated pneumonia were diagnosed. There was a significant decrease in the rate of ventilator-associated pneumonia in the povidone-iodine group when compared with the saline and control groups (3 of 36 patients [8%] vs. 12 of 31 patients [39%] and 13 of 31 patients [42%], respectively; p = .003 and .001, respectively). The length of stay and mortality in the surgical intensive care unit were not statistically different between the three groups.


CONCLUSIONS
The regular administration of povidone-iodine may be an effective strategy for decreasing the prevalence of ventilator-associated pneumonia in patients with severe head trauma.
Surgical Intensive Care Unit, INSERM U620, Hôpital Pontchaillou, 2 rue Henri Le Guilloux, 35033 Rennes cedex, France.
Philippe
P
Seguin
Michèle
M
Tanguy
Bruno
B
Laviolle
Olivier
O
Tirel
Yannick
Y
Mallédant
D000328:Adult; D000704:Analysis of Variance; D000891:Anti-Infective Agents, Local / Q000627:therapeutic use*; D005260:Female; D016489:Head Injuries, Closed / Q000628:therapy*; D006801:Humans; D008297:Male; D009960:Oropharynx; D011014:Pneumonia / Q000209:etiology / Q000517:prevention & control*; D011206:Povidone-Iodine / Q000627:therapeutic use*; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000009:adverse effects*
D000891:Anti-Infective Agents, Local; D011206:Povidone-Iodine