Intensive
Care Medicine Published: 05
October 2021
Purpose
Oral chlorhexidine is used widely for mechanically
ventilated patients to prevent pneumonia, but recent studies show an
association with excess mortality. We examined whether de-adoption of
chlorhexidine and parallel implementation of a standardized oral care bundle
reduces intensive care unit (ICU) mortality in mechanically ventilated
patients.
Methods
A stepped wedge cluster-randomized controlled trial with
concurrent process evaluation in 6 ICUs in Toronto, Canada. Clusters were
randomized to de-adopt chlorhexidine and implement a standardized oral care
bundle at 2-month intervals. The primary outcome was ICU mortality. Secondary
outcomes were time to infection-related ventilator-associated complications
(IVACs), oral procedural pain and oral health dysfunction. An exploratory post
hoc analysis examined time to extubation in survivors.
Results
A total of 3260 patients were enrolled; 1560 control, 1700
intervention. ICU mortality for the intervention and control periods were 399
(23.5%) and 330 (21.2%), respectively (adjusted odds ratio [aOR], 1.13; 95%
confidence interval [CI] 0.82 to 1.54; P = 0.46). Time to IVACs (adjusted
hazard ratio [aHR], 1.06; 95% CI 0.44 to 2.57; P = 0.90), time to
extubation (aHR 1.03; 95% CI 0.85 to 1.23; P = 0.79) (survivors) and oral
procedural pain (aOR, 0.62; 95% CI 0.34 to 1.10; P = 0.10) were similar
between control and intervention periods. However, oral health dysfunction
scores (− 0.96; 95% CI − 1.75 to − 0.17; P = 0.02) improved in the
intervention period.
Conclusion
Among mechanically ventilated ICU patients, no benefit was
observed for de-adoption of chlorhexidine and implementation of an oral care
bundle on ICU mortality, IVACs, oral procedural pain, or time to extubation.
The intervention may improve oral health.
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