Q: Oral decontamination with Chlorhexidine should be done on all intubated patients in as there is strong evidence that it decreases the incidence of Ventilator-Associated Pneumonia (VAP)?
A) True
B) False
Answer: B
Although oral decontamination with chlorhexidine is a common practice in ICUs to decrease the incidence of VAP, studies have failed to show strong evidence for it. In fact, the combined European and Latin American guidelines do not endorse it as there are some indications that it might even increase mortality. There is a suspicion that aspiration of chlorhexidine may lead to acute respiratory distress syndrome (ARDS).
#pulmonary
References:
1. Torres A, Niederman MS, Chastre J, et al. International ERS/ESICM/ESCMID/ALAT guidelines for the management of hospital-acquired pneumonia and ventilator-associated pneumonia: Guidelines for the management of hospital-acquired pneumonia (HAP)/ventilator-associated pneumonia (VAP) of the European Respiratory Society (ERS), European Society of Intensive Care Medicine (ESICM), European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and Asociación Latinoamericana del Tórax (ALAT). Eur Respir J 2017; 50.
2. Klompas M, Li L, Kleinman K, et al. Associations Between Ventilator Bundle Components and Outcomes. JAMA Intern Med 2016; 176:1277.
3. Price R, MacLennan G, Glen J, SuDDICU Collaboration. Selective digestive or oropharyngeal decontamination and topical oropharyngeal chlorhexidine for prevention of death in general intensive care: systematic review and network meta-analysis. BMJ 2014; 348:g2197.
A) True
B) False
Answer: B
Although oral decontamination with chlorhexidine is a common practice in ICUs to decrease the incidence of VAP, studies have failed to show strong evidence for it. In fact, the combined European and Latin American guidelines do not endorse it as there are some indications that it might even increase mortality. There is a suspicion that aspiration of chlorhexidine may lead to acute respiratory distress syndrome (ARDS).
#pulmonary
References:
1. Torres A, Niederman MS, Chastre J, et al. International ERS/ESICM/ESCMID/ALAT guidelines for the management of hospital-acquired pneumonia and ventilator-associated pneumonia: Guidelines for the management of hospital-acquired pneumonia (HAP)/ventilator-associated pneumonia (VAP) of the European Respiratory Society (ERS), European Society of Intensive Care Medicine (ESICM), European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and Asociación Latinoamericana del Tórax (ALAT). Eur Respir J 2017; 50.
2. Klompas M, Li L, Kleinman K, et al. Associations Between Ventilator Bundle Components and Outcomes. JAMA Intern Med 2016; 176:1277.
3. Price R, MacLennan G, Glen J, SuDDICU Collaboration. Selective digestive or oropharyngeal decontamination and topical oropharyngeal chlorhexidine for prevention of death in general intensive care: systematic review and network meta-analysis. BMJ 2014; 348:g2197.
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