title: Oral care with 0.12% chlorhexidine for the prevention of ventilator-associated pneumonia in critically ill children: randomised, controlled and double blind trial.
abstract: OBJECTIVE
  To test the effectiveness of oral care with 0.12% chlorhexidine in decreasing ventilator-associated pneumonia in critically ill children.
  
  
  METHODS
  Prospective, randomised, controlled, double-blind clinical trial performed in a paediatric critical care unit at a university hospital. The sample was composed of 96 mechanically ventilated children randomly allocated to the chlorhexidine group (oral care with a toothbrush and an antiseptic gel twice a day) and the placebo group (oral care with a toothbrush and a non-antiseptic gel twice a day). Microbiological analyses of oropharyngeal and tracheal secretions were performed 24, 48 and 96h after intubation. Chi-square, Fischer's exact and Mann-Whitney tests were applied (p≤0.05).
  
  
  RESULTS
  The chlorhexidine group was composed of 46 children, and the placebo group consisted of 50 children. Within these samples, 15 (32.6%) children in the chlorhexidine group and 16 (32.0%) children in the placebo group developed ventilator-associated pneumonia (p=0.949). Children in the chlorhexidine group without potentially pathogenic microflora in their oropharynx 24h after mechanical ventilation presented with fewer episodes of ventilator-associated pneumonia (p=0.019). The pathogen colonization profile of children with ventilator-associated pneumonia in the chlorhexidine group included Klebsiella pneumoniae, Escherichia coli, and Pseudomonas aeruginosa. In the placebo group, Pseudomonas aeruginosa and Escherichia coli were the predominant potentially pathogenic microorganisms. The intervention did not influence paediatric intensive care unit mortality (p=0.425), hospital length of stay (p=0.143), or paediatric intensive care unit length of stay (p=0.177).
  
  
  CONCLUSIONS
  The use of 0.12% chlorhexidine did not significantly modify the VAP incidence in a sample of mechanically ventilated children.
authors: Escola Paulista de Enfermagem - Universidade Federal de São Paulo, Brazil. dkusahara@unifesp.br
authors: Denise Miyuki
authors: DM
authors: Kusahara
authors: Maria Angélica Sorgini
authors: MA
authors: Peterlini
authors: Mavilde Luz Gonçalves
authors: ML
authors: Pedreira
mesh_terms: D002648:Child; D002675:Child, Preschool; D002710:Chlorhexidine / Q000008:administration & dosage*; D016638:Critical Illness; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009910:Oral Hygiene; D053717:Pneumonia, Ventilator-Associated / Q000209:etiology / Q000517:prevention & control*
chemical_list: D002710:Chlorhexidine