A Randomized Trial of Dental Brushing for Preventing Ventilator-Associated Pneumonia

摘要

Background: Poor oral hygiene is associated with respiratory pathogen colonization and second-nary lung infection. The impact of adding electric toothbrushing to oral care in order to reducenventilator-associated pneumonia (VAP) incidence is unknown.nMethods: The study design was a prospective, simple-blind, randomized trial of adult patientsnintubated for > 48 h. Controlling for exposure to antibiotic treatment, patients were randomizednto oral care every 8 h with 0.12% chlorhexidine digluconate (standard group) or standard oralncare plus electric toothbrushing (toothbrush group). VAP was documented by quantitativenrespiratory cultures. Mechanical ventilation (MV) duration, hospital ICU length of stay (LOS),nantibiotic use, and hospital ICU mortality were secondary end points.nResults: The study was terminated after randomizing 147 patients (74 toothbrush group) in anscheduled interim analysis. The two groups were comparable at baseline. The toothbrush groupnand standard group had similar rates of suspected VAP (20.3% vs 24.7%; p u0001 0.55). Afternadjustment for severity of illness and admission diagnosis, the incidence of microbiologicallyndocumented VAP was also similar in the two groups (hazard ratio, 0.84; 95% confidence interval, 0.41nto 1.73). The groups did not differ significantly in mortality, antibiotic-free days, duration of MV, ornhospital ICU LOS.nConclusions: Our findings suggest that the addition of electric toothbrushing to standard oral carenwith 0.12% chlorhexidine digluconate is not effective for the prevention of VAP.nTrial registration: ClinicalTrials.gov Identifier: NCT00842478 (CHEST 2009; 136:433–439)