A randomized trial of dental brushing for preventing ventilator-associated pneumonia.
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.


BACKGROUND
ClinicalTrials.gov Identifier: NCT00842478.
Pobo
Angel
A
Critical Care Department, Centro de Investigacíon Biomedica en Red Enfermedades Respiratorias.
Lisboa
Thiago
T
Critical Care Department, Centro de Investigacíon Biomedica en Red Enfermedades Respiratorias.
Rodriguez
Alejandro
A
Critical Care Department, Centro de Investigacíon Biomedica en Red Enfermedades Respiratorias.
Sole
Ramiro
R
Dentistry Care Department, Joan XXIII University Hospital, University Rovira i Virgili, Tarragona, Spain.
Magret
Mónica
M
Critical Care Department, Centro de Investigacíon Biomedica en Red Enfermedades Respiratorias.
Trefler
Sandra
S
Critical Care Department, Centro de Investigacíon Biomedica en Red Enfermedades Respiratorias.
Gómez
Frederic
F
Microbiology Department, Joan XXIII University Hospital, University Rovira i Virgili, Tarragona, Spain.
Rello
Jordi
J
Critical Care Department, Centro de Investigacíon Biomedica en Red Enfermedades Respiratorias. Electronic address: jrello.hj23.ics@gencat.cat.
D000328:Adult; D017677:Age Distribution; D000368:Aged; D000891:Anti-Infective Agents, Local / Q000494:pharmacology*; D002710:Chlorhexidine / Q000031:analogs & derivatives* / Q000494:pharmacology; D016001:Confidence Intervals; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D009910:Oral Hygiene; D053717:Pneumonia, Ventilator-Associated / Q000453:epidemiology / Q000517:prevention & control*; D011336:Probability; D011446:Prospective Studies; D012016:Reference Values; D012121:Respiration, Artificial / Q000009:adverse effects / Q000379:methods; D018570:Risk Assessment; D017678:Sex Distribution; D016037:Single-Blind Method; D018709:Statistics, Nonparametric; D015996:Survival Rate; D014099:Toothbrushing / Q000379:methods* / Q000706:statistics & numerical data
D000891:Anti-Infective Agents, Local; C010882:chlorhexidine gluconate; D002710:Chlorhexidine