Effect of oral chlorhexidine de-adoption and implementation of an oral care bundle on mortality for mechanically ventilated patients in the intensive care unit (CHORAL): a multi-center stepped wedge cluster-randomized controlled trial

Autor: Craig Dale, Orla Smith, Victoria A. McCredie, Eddy Fan, Andre Carlos Kajdacsy-Balla Amaral, Brian H Cuthbertson, Damon C. Scales, Ruxandra Pinto, Sarah Carbone, Louise Rose, Lisa Burry
Rok vydání: 2021
Předmět:
Zdroj: Intensive Care Medicine
Dale, C M, Rose, L, Carbone, S, Pinto, R, Smith, O M, Burry, L, Fan, E, Amaral, A C K B, McCredie, V A, Scales, D C & Cuthbertson, B H 2021, ' Effect of oral chlorhexidine de-adoption and implementation of an oral care bundle on mortality for mechanically ventilated patients in the intensive care unit (CHORAL) : a multi-center stepped wedge cluster-randomized controlled trial ', Intensive Care Medicine, vol. 47, no. 11, pp. 1295-1302 . https://doi.org/10.1007/s00134-021-06475-2
ISSN: 1432-1238
0342-4642
DOI: 10.1007/s00134-021-06475-2
Popis: Purpose Oral chlorhexidine is used widely for mechanically ventilated patients to prevent pneumonia, but recent studies show an association with excess mortality. We examined whether de-adoption of chlorhexidine and parallel implementation of a standardized oral care bundle reduces intensive care unit (ICU) mortality in mechanically ventilated patients. Methods A stepped wedge cluster-randomized controlled trial with concurrent process evaluation in 6 ICUs in Toronto, Canada. Clusters were randomized to de-adopt chlorhexidine and implement a standardized oral care bundle at 2-month intervals. The primary outcome was ICU mortality. Secondary outcomes were time to infection-related ventilator-associated complications (IVACs), oral procedural pain and oral health dysfunction. An exploratory post hoc analysis examined time to extubation in survivors. Results A total of 3260 patients were enrolled; 1560 control, 1700 intervention. ICU mortality for the intervention and control periods were 399 (23.5%) and 330 (21.2%), respectively (adjusted odds ratio [aOR], 1.13; 95% confidence interval [CI] 0.82 to 1.54; P = 0.46). Time to IVACs (adjusted hazard ratio [aHR], 1.06; 95% CI 0.44 to 2.57; P = 0.90), time to extubation (aHR 1.03; 95% CI 0.85 to 1.23; P = 0.79) (survivors) and oral procedural pain (aOR, 0.62; 95% CI 0.34 to 1.10; P = 0.10) were similar between control and intervention periods. However, oral health dysfunction scores (− 0.96; 95% CI − 1.75 to − 0.17; P = 0.02) improved in the intervention period. Conclusion Among mechanically ventilated ICU patients, no benefit was observed for de-adoption of chlorhexidine and implementation of an oral care bundle on ICU mortality, IVACs, oral procedural pain, or time to extubation. The intervention may improve oral health. Supplementary Information The online version contains supplementary material available at 10.1007/s00134-021-06475-2.
Databáze: OpenAIRE
Externí odkaz: