Oral secretions are aspirated by patients with endotracheal tubes, even when the endotracheal tube is properly inflated. Although raising the head of the bed can reduce aspiration, it does not completely prevent aspiration (1,2). Strategies that reduced the number of bacteria present in oropharyngeal secretions may help to reduce the incidence of Ventilator Associated Pneumonia (VAP). Oral application/rinses with chlorhexidine have been shown to reduce bacterial colony counts(1) or VAP rates(2).
Chlorhexidine is bacteriocidal against gram positive aerobic organisms. It adheres to the surface of the teeth and/or mucous membranes to provide prolonged activity. It is believed that the combined use of chlorhexidine, plus, an oral hygiene protocol that facilitates the removal of oral secretions, will help to reduce the incidence of VAP.
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1. Fourrier, F., Can-Pottier, E., Boutigny, H., Roussel-Delvallez, M., Jourdain, M., Chopin,
C. (2000). Effects of dental plaque antiseptic decontamination on bacterial
colonization and nosocomial infections in critically ill patients. Intensive Care
Medicine. 26: 1239-1247.
2. Koeman, M., van der Ven, A.J., Hak, E., Joore, C. A., Kaasjager, K., de Smet, A.G.,
Ramsay, G., Dormans, T., Aarts, L.P., de Bel, E. E., Hustinx, W.N., van der Tweed, I.,
Hoepelman, A.M., Bonten, M.J. (2006). Oral decontamination with chlorhexidine
reduces the incidence of ventilator-associated pneumonia. American Journal of
Respiratory Critical Care Medicine. 173: 1348-1355.
3. Orozco-Leo, M., Torres, A., Ferra, M., Piera, C., El-Ebirary, M., de la Bellacasa, JP., Rodriguez-Roisin, R. Semirecumbent position protects from pulmonary aspiration but not completely from gastro-esophageal reflux in mechanically ventilated patients. American Journal of Respiratory and Critical Care Medicine. 1995; 152: 1387-1390.
4. Torres, A., Serra-Batlles, J., Ros, E., Piera, C., Puig de la Bellacasta, J., Cobos, A., Lomena, F., Rodriguez-Roisin, R. Pulmonary aspiration of gastric contents in patients receiving mechanical ventilation: The effect of body position. Annals of Internal Medicine. 1992; 116: 540-543.