Evidence map›Paper›PMID 25317722›Full record

Trial reportChest2015

Preintubation application of oral chlorhexidine does not provide additional benefit in prevention of early-onset ventilator-associated pneumonia.

Cindy L Munro, Mary Jo Grap, Curtis N Sessler, Ronald K Elswick, Devanand Mangar, Rachel Karlnoski-Everall, Paula Cairns

Registry-linked trialOpen access · bronzeAbstract readMulticenter StudyRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Chest, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT00893763 (Oral Care Intervention in Mechanically Ventilated Adults), which is not on this map. Cited by 7 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
7citing papers in PubMed, 3 pooled it
2.1field-weighted citation impact, top 13% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT00893763 phase2completednot on this map

Oral Care Intervention in Mechanically Ventilated Adults

TypeinterventionalSponsorUniversity of South FloridaRan2008 to 2012Enrolled314ConditionsInfections, Hospital, Ventilator-Associated Pneumonia, Mechanical Ventilation ComplicationArmsPre-intubation CHX, Control
3 · Its place in the literature

Who cites it

7 citing papers in PubMed, 3 syntheses or guidelines pooled it, 26 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Pooled it
  4. Trial
  5. Article
  6. Article
  7. No Decrease in Early Ventilator-Associated Pneumonia After Early Use of Chlorhexidine.American journal of critical care : an official publication, American Association of Critical-Care Nurses · 2016
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors at 3 institutions in 1 country.

Cindy L MunroUniversity of South Florida, Tampa, FL. Electronic address: cmunro2@health.usf.edu.
Mary Jo GrapVirginia Commonwealth University, Richmond, VA.
Curtis N SesslerVirginia Commonwealth University, Richmond, VA.
Ronald K ElswickVirginia Commonwealth University, Richmond, VA.
Devanand MangarTampa General Hospital and Florida Gulf to Bay Anesthesiology, Tampa, FL.
Rachel Karlnoski-EverallTampa General Hospital and Florida Gulf to Bay Anesthesiology, Tampa, FL.
Paula CairnsUniversity of South Florida, Tampa, FL.
Virginia Commonwealth University · USTampa General Hospital · USUniversity of South Florida · US

Funding

ORAL CARE INTERVENTION IN MECHANICALLY VENTILATED ADULTSR01NR007652 · NINR · VIRGINIA COMMONWEALTH UNIVERSITY · PI KIP, KEVIN E · 2002 to 2017
$5.8M
NINR NIH HHS R01 NR007652NINR NIH HHS R01 NR07652
6 · The paper itself

Abstract

backgroundDaily application of oral chlorhexidine gluconate (CHX) following intubation to reduce the risk of ventilator-associated pneumonia (VAP) is now the standard of care in many ICUs. This randomized clinical trial evaluated the benefit of adding a preintubation CHX dose to the known benefit of postintubation CHX to reduce the risk of early-onset VAP. A secondary aim was to test the effect of a preintubation oral application of CHX on early endotracheal tube (ETT) colonization.

methodsSubjects (N = 314) were recruited from two teaching hospitals and were randomly assigned to oral application of 5 mL CHX 0.12% solution before intubation (intervention group, n = 157), or to a control group (n = 157) who received no CHX before intubation. All subjects received CHX bid after intubation. Groups were compared using a repeated-measures model with Clinical Pulmonary Infection Score (CPIS) as the response variable. In a planned subset of subjects, ETTs were cultured at extubation.

resultsApplication of a preintubation dose of CHX did not provide benefit over the intervention period beyond that afforded by daily oral CHX following intubation. ETT colonization at extubation was < 20% in both groups (no statistically significant difference). Mean CPIS remained below 6 (VAP threshold score) in both groups.

conclusionsAlthough it is feasible to deliver CHX prior to intubation (including emergent or urgent intubation), the results suggest that preintubation CHX may be inconsequential when the ventilator bundle, including daily oral CHX, is in place. During the preintubation period, providers should focus their attention on other critical activities. TRIAL REGISTRY: ClinicalTrials.gov; No.: NCT00893763; URL: www.clinicaltrials.gov.

Indexed as

Intubation, IntratrachealAdministration, OralAdultAgedChlorhexidineDisinfectantsFemaleHumansMaleMiddle AgedMouthOropharynxPneumonia, Ventilator-AssociatedChlorhexidineDisinfectants

Identifiers

PMID25317722
PMCPMC4314813
OpenAlexW2053925770

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.