title: Oral mucosal decontamination with chlorhexidine for the prevention of ventilator-associated pneumonia in children - a randomized, controlled trial.
abstract: OBJECTIVE
  To study the efficacy of oral mucosal decontamination with chlorhexidine gel for the prevention of ventilator-associated pneumonia in children between 3 months and 15 yrs.
  
  
  METHODS
  Double blind randomized placebo controlled trial.
  
  
  METHODS
  Pediatric intensive care unit of a tertiary care hospital in North India.
  
  
  METHODS
  Eligible participants were patients aged 3 months to 15 yrs who required orotracheal or nasotracheal intubation and mechanical ventilation. Two hundred eighty-three children admitted to the pediatric intensive care unit between November 2007 and April 2009 were screened. Eighty-six patients fulfilled the study requirements.
  
  
  METHODS
  Either 1% chlorhexidine or placebo gel was applied on the buccal mucosa at 8-hr intervals for the entire duration of ventilation, subject to a maximum of 21 days. Patients were followed up for the development of ventilator-associated pneumonia, diagnosed using the Centers for Disease Control and Prevention criteria.
  
  
  METHODS
  Incidence of ventilator-associated pneumonia, duration of hospital stay, duration of intensive care unit stay, mortality, and characteristics of organisms isolated.
  
  
  RESULTS
  Fourty-one children received 1% chlorhexidine, whereas 45 received placebo application. Patients of both groups were comparable with respect to baseline characteristics. Incidence of ventilator-associated pneumonia was 39.6/1,000 ventilator days with 1% chlorhexidine and 38.1/1,000 ventilator days with placebo (relative risk 1.03, confidence interval 0.44-2.42, p = .46). The duration of intensive care unit stay and hospital stay was a mean of 8.4 ± 5.8 vs. 9.6 ± 11.4 days (p = .58) and 16.1 ± 10.2 days vs. 15.1 ± 14.3 days (p = .19) with chlorhexidine and placebo, respectively. The mortality rates were similar in the two groups (p = .81). All but two isolates causing ventilator-associated pneumonia were gram-negative, with Acinetobacter species being the most common (14 of 26). No side effects of the applied gel were seen in either group.
  
  
  CONCLUSIONS
  Oral mucosal application on 1% chlorhexidine gel did not prevent the development of ventilator-associated pneumonia in children 3 months to 15 yrs age.
authors: From the Department of Pediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India.
authors: Meghna Raju
authors: MR
authors: Sebastian
authors: Rakesh
authors: R
authors: Lodha
authors: Arti
authors: A
authors: Kapil
authors: Sushil K
authors: SK
authors: Kabra
mesh_terms: D000150:Acinetobacter; D000151:Acinetobacter Infections / Q000150:complications; D000287:Administration, Topical; D000293:Adolescent; D000891:Anti-Infective Agents, Local / Q000008:administration & dosage / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D002710:Chlorhexidine / Q000008:administration & dosage / Q000627:therapeutic use*; D003666:Decontamination; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D007902:Length of Stay; D008297:Male; D009061:Mouth Mucosa / Q000382:microbiology*; D053717:Pneumonia, Ventilator-Associated / Q000382:microbiology / Q000517:prevention & control*; D012121:Respiration, Artificial / Q000009:adverse effects*
chemical_list: D000891:Anti-Infective Agents, Local; D002710:Chlorhexidine