ArticleCritical care (London, England)2026
Effectiveness of toothbrushing as a replacement for chlorhexidine in oral care, combined with head elevation for the prevention of ventilator-associated pneumonia in intensive care units: interrupted time-series analysis.
Article in Critical care (London, England), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
What it found
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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.
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.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
1 citing paper in PubMed.
- Beyond the Lungs: ICU Oral Care and Gut Resilience-A Hypothesis-Generating Narrative Review.Microorganisms · 2026Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
11 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThis study evaluated the effectiveness of replacing chlorhexidine-based oral care with toothbrushing and reinforcing head-of-bed elevation (HOBE) for the prevention of ventilator-associated pneumonia (VAP) in real-world practice using an interrupted time-series (ITS) analysis.
methodsThis quasi-experimental study was conducted in eight adult intensive care units (ICUs) of a 2,734-bed tertiary care hospital in Seoul, South Korea. The interventions, implemented in May 2023, included replacing chlorhexidine-based oral care with toothbrushing and strengthening HOBE adherence. ITS analysis was performed to assess the impact of the intervention on monthly VAP incidence rates from August 2022 through November 2024.
resultsAdherence to HOBE increased significantly from 84 to 95% after the intervention (P < 0.001). During the study period, 144 VAP cases occurred: 66 cases during 16,849 device-days in the pre-intervention period (3.9 per 1,000 device-days) and 78 cases during 32,185 device-days in the post-intervention period (2.4 per 1,000 device-days). ITS analysis demonstrated a significant decrease in both the level and trend of VAP incidence following the intervention (level change coefficient: -1.66, 95% confidence interval [CI]: -3.07 to -0.25, P = 0.029; trend change coefficient: -0.25, 95% CI: -0.45 to -0.06, P = 0.015). Sensitivity analyses using alternative transition windows and negative binomial models showed directionally consistent post-intervention declines, whereas estimates were attenuated and not statistically significant in the fully covariate-adjusted ITS model.
conclusionsImplementation of toothbrushing-based oral care combined with reinforced HOBE was followed by lower VAP incidence in the primary ITS analysis, supporting the feasibility of these aspiration-prevention measures in routine ICU practice.
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