title: Ventilator-associated pneumonia with or without toothbrushing: a randomized controlled trial.
abstract: Certain guidelines for the prevention of ventilator-associated pneumonia (VAP) recommend oral care with chlorhexidine, but none refer to the use of a toothbrush for oral hygiene. The role of toothbrush use has received scant attention. Thus, the objective of this study was to compare the incidence of VAP in critical care patients receiving oral care with and without manual brushing of the teeth. This was a randomized clinical trial developed in a 24-bed medical-surgical intensive care unit (ICU). Patients undergoing invasive mechanical ventilation for than 24 h were included. Patients were randomly assigned to receive oral care with or without toothbrushing. All patients received oral care with 0.12 % chlorhexidine digluconate. Tracheal aspirate samples were obtained during endotracheal intubation, then twice a week, and, finally, on extubation. There were no significant differences between the two groups of patients in the baseline characteristics. We found no statistically significant differences between the groups regarding the incidence of VAP (21 of 217 [9.7 %] with toothbrushing vs. 24 of 219 [11.0 %] without toothbrushing; odds ratio [OR] = 0.87, 95 % confidence interval [CI] = 0.469-1.615; p = 0.75). Adding manual toothbrushing to chlorhexidine oral care does not help to prevent VAP in critical care patients on mechanical ventilation.
authors.affiliation: Department of Critical Care, Hospital Universitario de Canarias, Ofra s/n. La Cuesta, La Laguna, 38320 Santa Cruz de Tenerife, Spain. lorentemartin@msn.com
authors.forename: L
authors.initials: L
authors.lastname: Lorente
authors.forename: M
authors.initials: M
authors.lastname: Lecuona
authors.forename: A
authors.initials: A
authors.lastname: Jiménez
authors.forename: S
authors.initials: S
authors.lastname: Palmero
authors.forename: E
authors.initials: E
authors.lastname: Pastor
authors.forename: N
authors.initials: N
authors.lastname: Lafuente
authors.forename: M J
authors.initials: MJ
authors.lastname: Ramos
authors.forename: M L
authors.initials: ML
authors.lastname: Mora
authors.forename: A
authors.initials: A
authors.lastname: Sierra
mesh_terms: D000328:Adult; D000368:Aged; D000891:Anti-Infective Agents, Local / Q000008:administration & dosage*; D002710:Chlorhexidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D003422:Critical Care; D005260:Female; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D007442:Intubation, Intratracheal; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D053717:Pneumonia, Ventilator-Associated / Q000382:microbiology / Q000517:prevention & control*; D012121:Respiration, Artificial / Q000009:adverse effects; D014099:Toothbrushing / Q000379:methods*; D014132:Trachea / Q000382:microbiology
chemical_list: D000891:Anti-Infective Agents, Local; C010882:chlorhexidine gluconate; D002710:Chlorhexidine