Oral care and ventilator-associated pneumonia

For a long time, oral care has been considered as a component of patient's comfort. Recently, the identification of oropharyngeal colonization as a main factor in the pathogenesis of ventilator-associated pneumonia (VAP) led to reconsider oral care as a possible means for prevention. In this purpose, mechanical (essentially tooth brushing) and pharmacological (oropharyngeal antiseptic and/or nonabsorbable antibiotics applications) approaches have been described. However, most of the published studies have weak methodology, ruling out any definitive conclusion regarding the relevance of such strategies. The technique to use for oral care, the type of decontaminant to choose, and the frequency of application are not well defined. For this indication, 2% chlorhexidine appears as the antiseptic of choice, but this formulation is not available in France. Local application of non-absorbable antibiotics is effective to reduce VAP and decrease mortality but the potential risk to develop bacterial resistance remains unclear.