Department of Nursing (Drs Kes and Aydin Yildirim), Faculty of Health Sciences, and Departments of Medical Microbiology (Dr Kuru) and Medical Pharmacology (Dr Ozdemir), Faculty of Medicine, Karabuk University, Demir-Celik Campus, Karabuk, Turkey; and Intensive Care Nursing (Ms Pazarlıoglu) and Anesthesia and Reanimation Intensive Care Unit (Dr Ciftci), Karabuk University Training and Research Hospital, Karabuk, Turkey.
J Trauma Nurs. 2021;28(4):228-234. doi: 10.1097/JTN.0000000000000590.
Evidence suggests that the effect of 0.12% chlorhexidine (CHX) use for oral care on the development of ventilator-associated pneumonia (VAP) and ventilator-associated tracheobronchitis (VAT) is lacking. Evidence-based approaches to the prevention of VAP and VAT are of paramount importance for improving patients' outcomes.
This study aimed to (1) compare the effect of 0.12% CHX use for oral care on preventing VAP and VAT with the placebo group, as well as (2) compare its effect on oral health and prevention of oral microbial colonization with the placebo group.
Prospective, single-blinded, randomized controlled trial performed in 2 intensive care units at a hospital. The sample comprised 57 mechanically ventilated adults randomly allocated to the 0.12% CHX group and the placebo group. Barnason's oral assessment guide was used to evaluate the oral health of both groups before oral care during the first 24 hr of tracheal intubation (Day 0) and at Day 2 and Day 3. Oropharyngeal secretion, endotracheal tube aspirate, and nonbronchoscopic bronchoalveolar lavage samples were collected on Day 0 and Day 3.
The rate of VAT development was not statistically different between the groups (p = .318). However, a significant difference existed in the rate of VAP development (p = .043). The frequency of oropharyngeal colonization significantly decreased in the 0.12% CHX group compared with the placebo group at Day 3 (p = .001).
The use of 0.12% CHX for oral care could be effective for VAP prevention and reducing microbial colonization in mechanically ventilated patients.
有证据表明，0.12%洗必泰（CHX）用于口腔护理对呼吸机相关性肺炎（VAP）和呼吸机相关性气管支气管炎（VAT）的发展的影响缺乏证据。预防 VAP 和 VAT 的循证方法对于改善患者的预后至关重要。
本研究旨在（1）比较 0.12% CHX 用于口腔护理对预防 VAP 和 VAT 的效果与安慰剂组的差异，以及（2）比较其对口腔健康和预防口腔微生物定植的效果与安慰剂组的差异。
在一家医院的 2 个重症监护病房进行了前瞻性、单盲、随机对照试验。样本包括 57 名接受机械通气的成人，随机分配到 0.12% CHX 组和安慰剂组。在气管插管后的前 24 小时（第 0 天）和第 2 天和第 3 天，使用 Barnason 的口腔评估指南评估两组的口腔健康状况。在第 0 天和第 3 天采集口咽分泌物、气管内抽吸物和非支气管镜肺泡灌洗液样本。
两组 VAT 发展的发生率无统计学差异（p=.318）。然而，VAP 发展的发生率存在显著差异（p=.043）。与安慰剂组相比，0.12% CHX 组在第 3 天口咽定植的频率显著降低（p=.001）。
在机械通气患者中，使用 0.12% CHX 进行口腔护理可能对预防 VAP 和减少微生物定植有效。
