Internal Medicine · 1 h ago
Chlorhexidine Added No Clear VAP Benefit in Medical ICU Trial
A pragmatic cluster-randomized crossover trial in six medical ICUs in India compared standardized oral care with and without 0.12% chlorhexidine. Among 1,035 mechanically ventilated adults, chlorhexidine did not significantly reduce ventilator-associated pneumonia or 28-day mortality; ICU stay was modestly longer in the chlorhexidine group.
- Trial included 1,035 adults across six medical ICUs.
- Chlorhexidine did not significantly reduce VAP incidence.
- Twenty-eight-day mortality did not differ significantly.
- ICU stay was 0.89 days longer with chlorhexidine.
Chlorhexidine has been used in oral-care bundles to prevent ventilator-associated pneumonia (VAP), although its benefit in non-cardiac-surgery ICUs is uncertain. In this prospective, pragmatic cluster-randomized crossover trial, six adult medical ICUs at one tertiary-care hospital in Bhubaneswar, India, used a standardized oral-care bundle either without chlorhexidine or with 0.12% chlorhexidine. The study included 1,035 adults ventilated for at least 48 hours and recorded 10,024 ventilator-days. The primary outcome was VAP incidence density, defined using a Clinical Pulmonary Infection Score above 6.
VAP incidence was 16.9 per 1,000 ventilator-days without chlorhexidine and 18.8 with it; the adjusted incidence rate ratio was 1.08 (95% CI 0.84–1.38; p=0.56). Twenty-eight-day mortality was 28.7% and 26.4%, respectively, with no significant adjusted difference (OR 0.87, 95% CI 0.65–1.15; p=0.33). ICU length of stay was 0.89 days longer in the chlorhexidine group (95% CI 0.19–1.58; p=0.013). Oral assessment and pain-observation scores did not differ.
The single-center trial found no clear incremental benefit from adding chlorhexidine to the bundle in this population. Its findings may not generalize beyond mixed medical ICUs at one hospital; the study does not establish why ICU stay was longer in the chlorhexidine arm.
In practice
For adults ventilated for at least 48 hours in mixed medical ICUs, this single-center cluster-randomized crossover trial found no significant reduction in VAP incidence or 28-day mortality when 0.12% chlorhexidine was added to a standardized oral-care bundle. ICU stay was modestly longer in the chlorhexidine arm, but the trial does not establish a cause for that difference. The findings do not demonstrate an incremental benefit in this setting and may not apply to other ICU populations or care protocols.
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Critical Care: Chlorhexidine within a standardized oral-care bundle for the prevention of ventilator-associated pneumonia: a pragmatic cluster-randomized crossover trial in six medical intensive care units ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.