Ventilator-associated pneumonia with or without toothbrushing: a randomized controlled trial

  • L. Lorente
  • M. Lecuona
  • A. Jiménez
  • S. Palmero
  • E. Pastor
  • N. Lafuente
  • M. J. Ramos
  • M. L. Mora
  • A. Sierra
Article

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.

Notes

Acknowledgments

This study was supported, in part, by a grant from Instituto de Salud Carlos III (I3SNS-INT-11-063) (Madrid, Spain).

Competing interests

The authors do not have any financial interests to disclose.

Funding

Hospital funding.

Trial registration

http://clinicaltrials.gov/

Identifier

NCT01477099

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Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • L. Lorente
    • 1
  • M. Lecuona
    • 2
  • A. Jiménez
    • 3
  • S. Palmero
    • 1
  • E. Pastor
    • 1
  • N. Lafuente
    • 1
  • M. J. Ramos
    • 2
  • M. L. Mora
    • 1
  • A. Sierra
    • 2
  1. 1.Department of Critical CareHospital Universitario de CanariasSanta Cruz de TenerifeSpain
  2. 2.Department of MicrobiologyHospital Universitario de CanariasSanta Cruz de TenerifeSpain
  3. 3.Research UnitHospital Universitario de CanariasSanta Cruz de TenerifeSpain

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