ORAL CARE INTERVENTIONS AND OROPHARYNGEAL COLONIZATION IN CHILDREN RECEIVING MECHANICAL VENTILATION

Background Recent progress in identification of oral microorganisms has shown that the oropharynx can be a site of origin for dissemination of pathogenic organisms to distant body sites, such as the lungs. Objective To compare the oropharyngeal microbiological pro file, duration of mechanical ventilation, and length of stay in the intensive care unit of children receiving mechanical ventilation who had pharmacological or nonpharmacological oral care. Methods A randomized and controlled study was performed in a pediatric intensive unit in Sao Paulo, Brazil. A total of 56 children were randomly assigned to an experimental group (n = 27, 48%) that received oral care with use of 0.12% chlorhexidine digluconate or a control group (n = 29, 52%) that received oral care without an antiseptic. Oropharyngeal secretions were collected and cultured on days 0, 2, and 4, and at discharge. Results The 2 groups had similar demographic characteristics, preexisting underlying diseases, and pharmacological, nutritional, and ventilatory support. Gram-negative bacteria were the predominant pathogens: Acinetobacter baumannii, Pseudomonas aeruginosa, Klebsiella pneumoniae, and Enterobacter species. The 2 groups did not differ significantly in the colonization of normal (P = .72) or pathogenic (P = .62) flora, in the duration of mechanical ventilation (P = .67), or in length of stay in the intensive care (P = .22). Conclusion Use of chlorhexidine combined with nonpharmacological oral care did not decrease the colonization profile, duration of mechanical ventilation, or length of stay in critically ill children receiving mechanical ventilation. (American Journal of Critical Care. 2009; 18: 319-329)