氯己定口腔黏膜冲洗液不能降低危重症儿童呼吸机相关性肺炎的发生率：一项随机对照试验。
Oral mucosal mouthwash with chlorhexidine does not reduce the incidence of ventilator-associated pneumonia in critically ill children: A randomised controlled trial.
机构信息
Istanbul Medeniyet University Goztepe Training and Research Hospital, Department of Paediatrics, Turkey.
Istanbul Medeniyet University Goztepe Training and Research Hospital, Department of Paediatrics, Pediatric Intensive Care Unit, Istanbul, Turkey.
出版信息
Aust Crit Care. 2022 Jul;35(4):336-344. doi: 10.1016/j.aucc.2021.06.011. Epub 2021 Aug 8.
BACKGROUND
Ventilator-associated pneumonia (VAP) is one of the most frequently encountered causes of hospital-acquired infection and results in high morbidity among intubated patients. Few trials have investigated the efficacy of oral care with chlorhexidine (CHX) mouthwash for the prevention of VAP in the paediatric population.
OBJECTIVES
The objective of this study was to assess the efficacy of CHX mouthwash in the prevention of VAP and to determine risk factors for VAP in children aged 1 month to 18 years admitted to the paediatric intensive care unit (PICU).
METHODS
This was a prospective, randomised, controlled, double-blind trial performed in the PICU. Patients were randomised into two groups receiving CHX (0.12%) (n = 88) or placebo (0.9% NaCl) (n = 86) and were followed up for VAP development. The main outcome measures were incidence of VAP, duration of hospital stay, duration of PICU stay, duration of ventilation, mortality, and the characteristics of organisms isolated in cases with VAP.
RESULTS
No difference was observed in the incidence of VAP and the type and distribution of organisms in the two groups (p > 0.05). In the CHX and placebo groups, we identified 21 and 22 patients with VAP, respectively. Incidence per 1000 ventilation days was 29.5 events in the CHX group and 35.1 events in the placebo group. Gram-negative bacteria were most common (71.4% in CHX vs. 54.5% in placebo). The use of 0.12% CHX did not influence hospital stay, PICU stay, ventilation, and mortality (p > 0.05). Multivariate analysis identified duration of ventilation as the only independent risk factor for VAP (p = 0.001).
CONCLUSION
The use of 0.12% CHX did not reduce VAP frequency among critically ill children. The only factor that increased VAP frequency was longer duration on ventilation. It appears that low concentration of CHX is not effective for VAP prevention, especially in the presence of multiresistant bacteria.
GOV IDENTIFIER
NCT04527276.
背景
呼吸机相关性肺炎（VAP）是医院获得性感染最常见的原因之一，会导致插管患者的发病率很高。很少有试验研究过洗必泰（CHX）漱口液口腔护理对预防儿科人群 VAP 的疗效。
目的
本研究旨在评估 CHX 漱口液预防 VAP 的疗效，并确定 1 个月至 18 岁入住儿科重症监护病房（PICU）的儿童发生 VAP 的危险因素。
方法
这是一项在 PICU 进行的前瞻性、随机、对照、双盲试验。患者随机分为接受 CHX（0.12%）（n=88）或安慰剂（0.9% NaCl）（n=86）的两组，并进行 VAP 发展的随访。主要观察指标为 VAP 的发生率、住院时间、PICU 住院时间、通气时间、死亡率以及 VAP 病例中分离的病原体的特征。
结果
两组 VAP 的发生率、病原体的类型和分布无差异（p＞0.05）。在 CHX 和安慰剂组中，我们分别发现 21 例和 22 例 VAP 患者。CHX 组每 1000 通气日的发生率为 29.5 例，安慰剂组为 35.1 例。革兰氏阴性菌最常见（CHX 组 71.4%，安慰剂组 54.5%）。使用 0.12% CHX 并不影响住院时间、PICU 住院时间、通气和死亡率（p＞0.05）。多变量分析确定通气时间是 VAP 的唯一独立危险因素（p=0.001）。
结论
使用 0.12% CHX 并不能降低危重症儿童 VAP 的发生率。唯一增加 VAP 发生率的因素是通气时间更长。似乎低浓度 CHX 对 VAP 预防无效，尤其是在存在多耐药菌的情况下。
GOV IDENTIFIER
NCT04527276。
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