Effect of oral care protocol with versus without chlorhexidine on mortality of mechanically ventilated patients: Prospective randomized controlled trial

Abstract

Introduction: For oral care and prevention of ventilator- associated pneumonia (VAP) in patients admitted to intensive care units (ICU), chlorhexidine gluconate is the commonly used antiseptic solution. Recent studies, however, have shown uncertainty regarding its benefit, with some reporting increased mortality in patients. Material and Methods: This randomised controlled study was performed on 154 patients who were receiving invasive mechanical ventilation for more than 48 hours. The patients were randomised into two study groups; in Group I oral care was provided with chlorhexidine gluconate solution, and in Group II a comprehensive oral care protocol that omitted chlorhexidine was adopted. The primary outcome of the study was patient outcome at 14 days after enrolment and secondary outcomes included incidence of VAP and oral health assessment. Results: We found that the oral hygiene in the study groups was comparable. The incidence of VAP was significantly higher in Group I as compared to Group II (40.2% vs 23.3%; P = 0.025). The mortality observed in Groups I and II at 14 days after study enrollment was 67.9% and 54.5% respectively (P = 0.002). In logistic regression analysis, the comorbidities, VAP and patients with underlying neurological conditions were found to be the independent factors affecting the mortality of patients. Conclusion: A comprehensive oral care regime consisting of mechanical disruption of dental plaque, moisturization of lips and oral cavity compared to chlorhexidine -based oral care is found to be more effective in reducing VAP in mechanically ventilated patients admitted in a general ICU.