title: Prehospital oral chlorhexidine does not reduce the rate of ventilator-associated pneumonia among critically ill trauma patients: A prospective concurrent-control study.
abstract: OBJECTIVE
  The purpose of the study was to test the hypothesis that prehospital oral chlorhexidine administered to intubated trauma patients will decrease the Clinical Pulmonary Infection Score (CPIS) during the first 2 days of hospitalization.
  
  
  METHODS
  Prospective interventional concurrent-control study of all intubated adult trauma patients transported by air ambulance to a 711-bed Midwestern academic trauma center over a 1-year period. Patients transported by 2 university-based helicopters were treated with oral chlorhexidine after intubation, and the control group was patients transported by other air transport services.
  
  
  RESULTS
  Sixty-seven patients were enrolled, of which 23 received chlorhexidine (9 patients allocated to the intervention were not treated). The change in CPIS score was no different between the intervention and control groups by intention to treat (1.06- vs 1.40-point reduction, P = .520), and no difference was observed in tracheal colonization (29.0% vs 36.7%, P = .586). No differences were observed in the rate of clinical pneumonia (8.7% vs 8.6%, P = .987) or mortality (P = .196) in the per-protocol chlorhexidine group.
  
  
  CONCLUSIONS
  The prehospital administration of oral chlorhexidine does not reduce the CPIS score over the first 48 hours of admission for intubated trauma patients. Further study should explore other prehospital strategies of reducing complications of critical illness.
authors.affiliation: Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, IA; Division of Critical Care, Department of Anesthesia, University of Iowa Carver College of Medicine, Iowa City, IA. Electronic address: nicholas-mohr@uiowa.edu.
authors.forename: Nicholas M
authors.initials: NM
authors.lastname: Mohr
authors.affiliation: Department of Surgery, University of Iowa Carver College of Medicine, Iowa City, IA. Electronic address: carlos-pelaezgil@uiowa.edu.
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Pelaez Gil
authors.affiliation: Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, IA. Electronic address: kari-harland@uiowa.edu.
authors.forename: Karisa K
authors.initials: KK
authors.lastname: Harland
authors.affiliation: Department of Pharmaceutical Services, University of Iowa Hospitals and Clinics, Iowa City, IA. Electronic address: brett-faine@uiowa.edu.
authors.forename: Brett
authors.initials: B
authors.lastname: Faine
authors.affiliation: Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, IA. Electronic address: andrew-stoltze@uiowa.edu.
authors.forename: Andrew
authors.initials: A
authors.lastname: Stoltze
authors.affiliation: Division of Critical Care, Department of Anesthesia, University of Iowa Carver College of Medicine, Iowa City, IA; Department of Anesthesia, University of Iowa Carver College of Medicine, Iowa City, IA. Electronic address: kent-pearson@uiowa.edu.
authors.forename: Kent
authors.initials: K
authors.lastname: Pearson
authors.affiliation: Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, IA. Electronic address: azeemuddin-ahmed@uiowa.edu.
authors.forename: Azeemuddin
authors.initials: A
authors.lastname: Ahmed
mesh_terms: D000284:Administration, Oral; D000328:Adult; D017732:Air Ambulances; D000891:Anti-Infective Agents, Local / Q000627:therapeutic use*; D002710:Chlorhexidine / Q000627:therapeutic use*; D016638:Critical Illness; D004632:Emergency Medical Services / Q000379:methods*; D005260:Female; D006760:Hospitalization; D006801:Humans; D007442:Intubation, Intratracheal; D008297:Male; D008875:Middle Aged; D010360:Patient Transfer; D053717:Pneumonia, Ventilator-Associated / Q000517:prevention & control*; D011446:Prospective Studies; D014193:Trauma Centers; D014947:Wounds and Injuries / Q000628:therapy*
chemical_list: D000891:Anti-Infective Agents, Local; D002710:Chlorhexidine
keywords: Chlorhexidine; Emergency medical services; Prevention & control; Ventilator-associated pneumonia; Wounds and injuries