title: No Decrease in Early Ventilator-Associated Pneumonia After Early Use of Chlorhexidine.
abstract: BACKGROUND
  Oral chlorhexidine prophylaxis can decrease occurrence of ventilator-associated pneumonia. However, the importance of timing has never been fully explored.
  
  
  OBJECTIVE
  To see if early administration of oral chlorhexidine is associated with lower incidence of early ventilator-associated pneumonia (within 5 days of admission to intensive care unit) in intubated air ambulance patients.
  
  
  METHODS
  A single-center, retrospective cohort study of intubated adults transported by a university-based air ambulance service and admitted to a surgical intensive care unit from July 2011 through April 2013. Primary exposure was time from helicopter retrieval to the first dose of oral chlorhexidine in the intensive care unit. Early chlorhexidine was defined as receipt of the drug within 6 hours of helicopter departure. The primary outcome was clinical diagnosis of early ventilator-associated pneumonia. Patients who were less than 18 years old, died within 72 hours of admission, or had pneumonia at admission were excluded.
  
  
  RESULTS
  Among 134 patients, 49% were treated with chlorhexidine before 6 hours, 84% were treated before 12 hours, and 11% were treated for early pneumonia. Early chlorhexidine (before 6 hours; 15%) was not associated (P = .21) with early pneumonia (8%). Furthermore, median times to chlorhexidine did not differ significantly (P = .23) between patients in whom pneumonia developed (5.2 hours) and patients with no pneumonia (6.1 hours).
  
  
  CONCLUSIONS
  Early administration of oral chlorhexidine in intubated patients was not associated with a reduction in the incidence of ventilator-associated pneumonia in a surgical intensive care unit with high rates of chlorhexidine administration before 12 hours.
authors.affiliation: Terrence Wong is a medical student, Andrew J. Stoltze is a resident physician, Kari K. Harland is a biostatistician, and Azeemuddin Ahmed is a clinical professor, Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa. Adam B. Schlichting is a clinical assistant professor, Department of Emergency Medicine and Department of Internal Medicine, Division of Pulmonary, Critical Care and Occupational Medicine, University of Iowa Carver College of Medicine. Brian M. Fuller is a clinical assistant professor, Department of Anesthesiology, Division of Emergency Medicine and Division of Critical Care, Washington University School of Medicine, St Louis, Missouri. Amanda Peacock is an advanced registered nurse practitioner, Department of Anesthesia, Division of Critical Care, University of Iowa Carver College of Medicine. Nicholas Mohr is a clinical assistant professor, Department of Emergency Medicine and Department of Anesthesia, Division of Critical Care, University of Iowa Carver College of Medicine.
authors.forename: Terrence
authors.initials: T
authors.lastname: Wong
authors.affiliation: Terrence Wong is a medical student, Andrew J. Stoltze is a resident physician, Kari K. Harland is a biostatistician, and Azeemuddin Ahmed is a clinical professor, Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa. Adam B. Schlichting is a clinical assistant professor, Department of Emergency Medicine and Department of Internal Medicine, Division of Pulmonary, Critical Care and Occupational Medicine, University of Iowa Carver College of Medicine. Brian M. Fuller is a clinical assistant professor, Department of Anesthesiology, Division of Emergency Medicine and Division of Critical Care, Washington University School of Medicine, St Louis, Missouri. Amanda Peacock is an advanced registered nurse practitioner, Department of Anesthesia, Division of Critical Care, University of Iowa Carver College of Medicine. Nicholas Mohr is a clinical assistant professor, Department of Emergency Medicine and Department of Anesthesia, Division of Critical Care, University of Iowa Carver College of Medicine. adam-schlichting@uiowa.edu.
authors.forename: Adam B
authors.initials: AB
authors.lastname: Schlichting
authors.affiliation: Terrence Wong is a medical student, Andrew J. Stoltze is a resident physician, Kari K. Harland is a biostatistician, and Azeemuddin Ahmed is a clinical professor, Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa. Adam B. Schlichting is a clinical assistant professor, Department of Emergency Medicine and Department of Internal Medicine, Division of Pulmonary, Critical Care and Occupational Medicine, University of Iowa Carver College of Medicine. Brian M. Fuller is a clinical assistant professor, Department of Anesthesiology, Division of Emergency Medicine and Division of Critical Care, Washington University School of Medicine, St Louis, Missouri. Amanda Peacock is an advanced registered nurse practitioner, Department of Anesthesia, Division of Critical Care, University of Iowa Carver College of Medicine. Nicholas Mohr is a clinical assistant professor, Department of Emergency Medicine and Department of Anesthesia, Division of Critical Care, University of Iowa Carver College of Medicine.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Stoltze
authors.affiliation: Terrence Wong is a medical student, Andrew J. Stoltze is a resident physician, Kari K. Harland is a biostatistician, and Azeemuddin Ahmed is a clinical professor, Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa. Adam B. Schlichting is a clinical assistant professor, Department of Emergency Medicine and Department of Internal Medicine, Division of Pulmonary, Critical Care and Occupational Medicine, University of Iowa Carver College of Medicine. Brian M. Fuller is a clinical assistant professor, Department of Anesthesiology, Division of Emergency Medicine and Division of Critical Care, Washington University School of Medicine, St Louis, Missouri. Amanda Peacock is an advanced registered nurse practitioner, Department of Anesthesia, Division of Critical Care, University of Iowa Carver College of Medicine. Nicholas Mohr is a clinical assistant professor, Department of Emergency Medicine and Department of Anesthesia, Division of Critical Care, University of Iowa Carver College of Medicine.
authors.forename: Brian M
authors.initials: BM
authors.lastname: Fuller
authors.affiliation: Terrence Wong is a medical student, Andrew J. Stoltze is a resident physician, Kari K. Harland is a biostatistician, and Azeemuddin Ahmed is a clinical professor, Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa. Adam B. Schlichting is a clinical assistant professor, Department of Emergency Medicine and Department of Internal Medicine, Division of Pulmonary, Critical Care and Occupational Medicine, University of Iowa Carver College of Medicine. Brian M. Fuller is a clinical assistant professor, Department of Anesthesiology, Division of Emergency Medicine and Division of Critical Care, Washington University School of Medicine, St Louis, Missouri. Amanda Peacock is an advanced registered nurse practitioner, Department of Anesthesia, Division of Critical Care, University of Iowa Carver College of Medicine. Nicholas Mohr is a clinical assistant professor, Department of Emergency Medicine and Department of Anesthesia, Division of Critical Care, University of Iowa Carver College of Medicine.
authors.forename: Amanda
authors.initials: A
authors.lastname: Peacock
authors.affiliation: Terrence Wong is a medical student, Andrew J. Stoltze is a resident physician, Kari K. Harland is a biostatistician, and Azeemuddin Ahmed is a clinical professor, Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa. Adam B. Schlichting is a clinical assistant professor, Department of Emergency Medicine and Department of Internal Medicine, Division of Pulmonary, Critical Care and Occupational Medicine, University of Iowa Carver College of Medicine. Brian M. Fuller is a clinical assistant professor, Department of Anesthesiology, Division of Emergency Medicine and Division of Critical Care, Washington University School of Medicine, St Louis, Missouri. Amanda Peacock is an advanced registered nurse practitioner, Department of Anesthesia, Division of Critical Care, University of Iowa Carver College of Medicine. Nicholas Mohr is a clinical assistant professor, Department of Emergency Medicine and Department of Anesthesia, Division of Critical Care, University of Iowa Carver College of Medicine.
authors.forename: Kari K
authors.initials: KK
authors.lastname: Harland
authors.affiliation: Terrence Wong is a medical student, Andrew J. Stoltze is a resident physician, Kari K. Harland is a biostatistician, and Azeemuddin Ahmed is a clinical professor, Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa. Adam B. Schlichting is a clinical assistant professor, Department of Emergency Medicine and Department of Internal Medicine, Division of Pulmonary, Critical Care and Occupational Medicine, University of Iowa Carver College of Medicine. Brian M. Fuller is a clinical assistant professor, Department of Anesthesiology, Division of Emergency Medicine and Division of Critical Care, Washington University School of Medicine, St Louis, Missouri. Amanda Peacock is an advanced registered nurse practitioner, Department of Anesthesia, Division of Critical Care, University of Iowa Carver College of Medicine. Nicholas Mohr is a clinical assistant professor, Department of Emergency Medicine and Department of Anesthesia, Division of Critical Care, University of Iowa Carver College of Medicine.
authors.forename: Azeemuddin
authors.initials: A
authors.lastname: Ahmed
authors.affiliation: Terrence Wong is a medical student, Andrew J. Stoltze is a resident physician, Kari K. Harland is a biostatistician, and Azeemuddin Ahmed is a clinical professor, Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa. Adam B. Schlichting is a clinical assistant professor, Department of Emergency Medicine and Department of Internal Medicine, Division of Pulmonary, Critical Care and Occupational Medicine, University of Iowa Carver College of Medicine. Brian M. Fuller is a clinical assistant professor, Department of Anesthesiology, Division of Emergency Medicine and Division of Critical Care, Washington University School of Medicine, St Louis, Missouri. Amanda Peacock is an advanced registered nurse practitioner, Department of Anesthesia, Division of Critical Care, University of Iowa Carver College of Medicine. Nicholas Mohr is a clinical assistant professor, Department of Emergency Medicine and Department of Anesthesia, Division of Critical Care, University of Iowa Carver College of Medicine.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Mohr
mesh_terms: D000284:Administration, Oral; D017732:Air Ambulances; D000891:Anti-Infective Agents, Local / Q000008:administration & dosage / Q000627:therapeutic use*; D002710:Chlorhexidine / Q000008:administration & dosage / Q000627:therapeutic use*; D015331:Cohort Studies; D003422:Critical Care / Q000379:methods*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007442:Intubation, Intratracheal; D008297:Male; D008875:Middle Aged; D053717:Pneumonia, Ventilator-Associated / Q000517:prevention & control*; D012189:Retrospective Studies; D013997:Time Factors
chemical_list: D000891:Anti-Infective Agents, Local; D002710:Chlorhexidine