Oral mucosal mouthwash with chlorhexidine does not reduce the incidence of ventilator-associated pneumonia in critically ill children: A randomised controlled trial

Safdar, 2005, The pathogenesis of ventilator-associated pneumonia: its relevance to developing effective strategies for prevention, Respir Care, 50, 725 Patria, 2013, Ventilator-associated pneumonia in an Italian pediatric intensive care unit: a prospective study, World J Pediatr, 9, 365, 10.1007/s12519-013-0444-y O'horo, 2012, Is the gram stain useful in the microbiologic diagnosis of VAP? A meta-analysis, Clin Infect Dis, 55, 551, 10.1093/cid/cis512 Joram, 2012, Healthcare-associated infection prevention in pediatric intensive care units: a review, Eur J Clin Microbiol Infect Dis, 31, 2481, 10.1007/s10096-012-1611-0 Kalanuria, 2014, Ventilator-associated pneumonia in the ICU, Crit Care, 18, 208, 10.1186/cc13775 Venkatachalam, 2011, The diagnostic dilemma of ventilator-associated pneumonia in critically ill children, Pediatr Crit Care Med, 12, 286, 10.1097/PCC.0b013e3181fe2ffb Bigham, 2009, Ventilator-associated pneumonia in the pediatric intensive care unit: characterizing the problem and implementing a sustainable solution, J Pediatr, 154, 10.1016/j.jpeds.2008.10.019 Huskins, 2012, Quality improvement interventions to prevent healthcare-associated infections in neonates and children, Curr Opin Pediatr, 24, 103, 10.1097/MOP.0b013e32834ebdc3 Liu, 2013, Risk factors of ventilator-associated pneumonia in pediatric intensive care unit: a systematic review and meta-analysis, J Thorac Dis, 5, 525 Whittaker, 1996, Mechanisms of adhesion by oral bacteria, Annu Rev Microbiol, 50, 513, 10.1146/annurev.micro.50.1.513 Zolfaghari, 2011, The tracheal tube: gateway to ventilator-associated pneumonia, Crit Care, 15, 310, 10.1186/cc10352 Tablan, 2004, Guidelines for preventing health-care--associated pneumonia, 2003: recommendations of CDC and the healthcare infection control practices advisory committee, MMWR Recomm Rep, 53, 1 Koff, 2011, Reduction in ventilator associated pneumonia in a mixed intensive care unit after initiation of a novel hand hygiene program, J Crit Care, 26, 489, 10.1016/j.jcrc.2010.12.013 Coffin, 2008, Strategies to prevent ventilator-associated pneumonia in acute care hospitals, Infect Control Hosp Epidemiol, 29, S31, 10.1086/591062 Improvement IFH. How-to-Guide: prevent a ventilator associated pneumonia [Available from: http://www.ihi.org/IHI/Topics/. De Neef, 2019, Effectiveness of a ventilator care bundle to prevent ventilator-associated pneumonia at the PICU: a systematic review and meta-analysis, Pediatr Crit Care Med, 20, 474, 10.1097/PCC.0000000000001862 Klompas, 2016, Associations between ventilator bundle components and outcomes, JAMA Intern Med, 176, 1277, 10.1001/jamainternmed.2016.2427 Sinuff, 2013, Implementation of clinical practice guidelines for ventilator-associated pneumonia: a multicenter prospective study, Crit Care Med, 41, 15, 10.1097/CCM.0b013e318265e874 Zhang, 2014, The effectiveness of different concentrations of chlorhexidine for prevention of ventilator-associated pneumonia: a meta-analysis, J Clin Nurs, 23, 1461, 10.1111/jocn.12312 Labeau, 2011, Prevention of ventilator-associated pneumonia with oral antiseptics: a systematic review and meta-analysis, Lancet Infect Dis, 11, 845, 10.1016/S1473-3099(11)70127-X Meinberg, 2012, The use of 2% chlorhexidine gel and toothbrushing for oral hygiene of patients receiving mechanical ventilation: effects on ventilator-associated pneumonia, Rev Bras Ter Intensiva, 24, 369, 10.1590/S0103-507X2012000400013 Li, 2013, Oral topical decontamination for preventing ventilator-associated pneumonia: a systematic review and meta-analysis of randomized controlled trials, J Hosp Infect, 84, 283, 10.1016/j.jhin.2013.04.012 Shi, 2013, Oral hygiene care for critically ill patients to prevent ventilator-associated pneumonia, Cochrane Database Syst Rev, 8, 10.1002/14651858.CD008367.pub2 Klompas, 2014, Reappraisal of routine oral care with chlorhexidine gluconate for patients receiving mechanical ventilation: systematic review and meta-analysis, JAMA Intern Med, 174, 751, 10.1001/jamainternmed.2014.359 Osman, 2020, The incidence of ventilator-associated pneumonia (VAP) in a tertiary-care center: comparison between pre- and post-VAP prevention bundle, J Infect Publ Health, 13, 552, 10.1016/j.jiph.2019.09.015 Kusahara, 2012, Oral care with 0.12% chlorhexidine for the prevention of ventilator-associated pneumonia in critically ill children: randomised, controlled and double blind trial, Int J Nurs Stud, 49, 1354, 10.1016/j.ijnurstu.2012.06.005 Jácomo, 2011, Effect of oral hygiene with 0.12% chlorhexidine gluconate on the incidence of nosocomial pneumonia in children undergoing cardiac surgery, Infect Control Hosp Epidemiol, 32, 591, 10.1086/660018 Sebastian, 2012, Oral mucosal decontamination with chlorhexidine for the prevention of ventilator-associated pneumonia in children - a randomized, controlled trial, Pediatr Crit Care Med, 13, e305, 10.1097/PCC.0b013e31824ea119 Schulz, 2010, CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials, J Pharmacol Pharmacother, 1, 100, 10.4103/0976-500X.72352 Dat, 2018, Continuous versus intermittent endotracheal cuff pressure control for the prevention of ventilator-associated respiratory infections in Vietnam: study protocol for a randomised controlled trial, Trials, 19, 217, 10.1186/s13063-018-2587-6 Rath, 2013, Comparative clinical and microbiological efficacy of mouthwashes containing 0.2% and 0.12% chlorhexidine, Dent Res J (Isfahan), 10, 364 Ames, 2011, Effects of systematic oral care in critically ill patients: a multicenter study, Am J Crit Care, 20, e103, 10.4037/ajcc2011359 Garner, 1988, CDC definitions for nosocomial infections, 1988, Am J Infect Contr, 16, 128, 10.1016/0196-6553(88)90053-3 Wall, 2008, Evidence-based algorithms for diagnosing and treating ventilator-associated pneumonia, J Hosp Med, 3, 409, 10.1002/jhm.317 Foglia, 2007, Ventilator-associated pneumonia in neonatal and pediatric intensive care unit patients, Clin Microbiol Rev, 20, 409, 10.1128/CMR.00041-06 Langley, 2005, Defining pneumonia in critically ill infants and children, Pediatr Crit Care Med, 6, S9, 10.1097/01.PCC.0000161932.73262.D7 Aa, 2013, vol. 9, 251 Pollack, 1996, PRISM III: an updated pediatric risk of mortality score, Crit Care Med, 24, 743, 10.1097/00003246-199605000-00004 Fourrier, 2005, Effect of gingival and dental plaque antiseptic decontamination on nosocomial infections acquired in the intensive care unit: a double-blind placebo-controlled multicenter study, Crit Care Med, 33, 1728, 10.1097/01.CCM.0000171537.03493.B0 Panchabhai, 2009, Oropharyngeal cleansing with 0.2% chlorhexidine for prevention of nosocomial pneumonia in critically ill patients: an open-label randomized trial with 0.01% potassium permanganate as control, Chest, 135, 1150, 10.1378/chest.08-1321 Johnstone, 2010, Oral hygiene care in the pediatric intensive care unit: practice recommendations, Pediatr Nurs, 36, 85 Segers, 2006, Prevention of nosocomial infection in cardiac surgery by decontamination of the nasopharynx and oropharynx with chlorhexidine gluconate: a randomized controlled trial, J Am Med Assoc, 296, 2460, 10.1001/jama.296.20.2460 De Cristofano, 2016, Implementation of a ventilator-associated pneumonia prevention bundle in a single PICU, Pediatr Crit Care Med, 17, 451, 10.1097/PCC.0000000000000714 Grap, 2004, Duration of action of a single, early oral application of chlorhexidine on oral microbial flora in mechanically ventilated patients: a pilot study, Heart Lung, 33, 83, 10.1016/j.hrtlng.2003.12.004 Cieplik, 2019, Resistance toward chlorhexidine in oral bacteria - is there cause for concern?, Front Microbiol, 10, 587, 10.3389/fmicb.2019.00587 Bonten, 2004, Risk factors for ventilator-associated pneumonia: from epidemiology to patient management, Clin Infect Dis, 38, 1141, 10.1086/383039 Samransamruajkit, 2010, Effect of frequency of ventilator circuit changes (3 vs 7 days) on the rate of ventilator-associated pneumonia in PICU, J Crit Care, 25, 56, 10.1016/j.jcrc.2009.03.005 Elward, 2002, Ventilator-associated pneumonia in pediatric intensive care unit patients: risk factors and outcomes, Pediatrics, 109, 758, 10.1542/peds.109.5.758 Chastre, 2002, Ventilator-associated pneumonia, Am J Respir Crit Care Med, 165, 867, 10.1164/ajrccm.165.7.2105078 Blot, 2008, Limiting the attributable mortality of nosocomial infection and multidrug resistance in intensive care units, Clin Microbiol Infect, 14, 5, 10.1111/j.1469-0691.2007.01835.x Parreco, 2020, Multi-Center outcomes of chlorhexidine oral decontamination in intensive care units, Surg Infect (Larchmt), 21, 659, 10.1089/sur.2019.172 Price, 2014, Selective digestive or oropharyngeal decontamination and topical oropharyngeal chlorhexidine for prevention of death in general intensive care: systematic review and network meta-analysis, BMJ, 348, 10.1136/bmj.g2197 Deschepper, 2018, Effects of chlorhexidine gluconate oral care on hospital mortality: a hospital-wide, observational cohort study, Intensive Care Med, 44, 1017, 10.1007/s00134-018-5171-3 Blot, 2021, Antiseptic mouthwash, the nitrate-nitrite-nitric oxide pathway, and hospital mortality: a hypothesis generating review, Intensive Care Med, 47, 28, 10.1007/s00134-020-06276-z Lizy, 2014, Cuff pressure of endotracheal tubes after changes in body position in critically ill patients treated with mechanical ventilation, Am J Crit Care, 23, e1, 10.4037/ajcc2014489