Letter to the Editor
Chlorhexidine and ventilator-associated pneumonia
Clorhexidina y neumonía asociada al ventilador
Fausto Marcos Guerrero-Toapanta
, Yeimi del Carmen Herrera-Parra
Corresponding author
Unidad de Cuidados Intensivos, Hospital de Especialidades Carlos Andrade Marín, Quito, Ecuador
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We would like to emphasize the importance of oral hygiene with chlorhexidine in critically ill patients on IMV.</p><p id="par0010" class="elsevierStylePara elsevierViewall">In recent years, chlorhexidine has been stigmatized due to a possibly higher mortality rate in non-cardiac surgical patients on IMV,<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3</span></a> a greater impact on reducing VAP in cardiac surgery patients, and no reduction in the incidence of VAP in non-cardiac surgery patients.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> This has led to its optional use in VAP prevention bundles. However, it remains a pharmacological measure for VAP prevention with moderate evidence and a strong recommendation grade according to the updated clinical practice guidelines of the Pneumonia Zero campaign.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Although VAP prevention strategies are multimodal it is crucial to reduce oropharyngeal colonization and prevent the passage of microorganisms (micro-aspiration) into the subglottic region and lower respiratory tract, a phenomenon known as transcolonization.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The article published by Cruz compiles the evidence available from randomized clinical trials using chlorhexidine to reduce microbial load in the oropharynx. As it happens in other studies, there is variability in the concentration of chlorhexidine used, ranging from 0.12% to 2% that, however, does not affect the final outcome of this study. Similarly, there is variability in the way this antiseptic is used as part of oral hygiene protocols. Based on the evidence currently available, we believe that oral hygiene with chlorhexidine should continue to be a valid option, following a standardized protocol, in patients on invasive mechanical ventilation. It is a cost-effective resource accessible to all health centers that has proven beneficial in VAP prevention, especially in countries with low-to-medium economic resources where other preventive measures may be more expensive.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0020" class="elsevierStylePara elsevierViewall">We hereby declare that this work is self-funded.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflicts of interest</span><p id="par0025" class="elsevierStylePara elsevierViewall">None declared.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Funding" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Conflicts of interest" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Does chlorhexidine reduce the incidence of ventilator-associated pneumonia in ICU patients? A systematic review and meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "J.C. Cruz" 1 => "C.K. Martins" 2 => "J.E.V. Piassi" 3 => "I.R. García Jr." 4 => "J.F. Santiago Jr." 5 => "L.P. Faverani" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.medine.2022.11.002" "Revista" => array:5 [ "tituloSerie" => "Med Intensiva (Engl Ed)" "fecha" => "2023" "volumen" => "47" "paginaInicial" => "437" "paginaFinal" => "444" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Selective digestive or oropharyngeal decontamination and topical oropharyngeal chlorhexidine for prevention of death in general intensive care: systematic review and network meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "R. Price" 1 => "G. MacLennan" 2 => "J. Glen" 3 => "SuDDICU" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/bmj.g2197" "Revista" => array:5 [ "tituloSerie" => "BMJ" "fecha" => "2014" "volumen" => "348" "paginaInicial" => "g2197" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24687313" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Reappraisal of routine oral care with chlorhexidine gluconate for patients receiving mechanical ventilation: systematic review and meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M. Klompas" 1 => "K. Speck" 2 => "M.D. Howell" 3 => "L.R. Greene" 4 => "S.M. Berenholtz" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/jamainternmed.2014.359" "Revista" => array:5 [ "tituloSerie" => "JAMA Intern Med" "fecha" => "2014" "volumen" => "174" "paginaInicial" => "751" "paginaFinal" => "761" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Equipo Neumonía Zero. Actualización de las recomendaciones del proyecto Neumonía Zero" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "S. Arias-Rivera" 1 => "R. Jam-Gatell" 2 => "X. Nuvials-Casals" 3 => "M. Vázquez-Calatayud" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.enfi.2022.05.005" "Revista" => array:6 [ "tituloSerie" => "Enferm Intensiva" "fecha" => "2022" "volumen" => "33" "paginaInicial" => "S17" "paginaFinal" => "S30" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/35911624" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ventilator-associated pneumonia: the central role of transcolonization" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R. Soussan" 1 => "C. Schimpf" 2 => "B. Pilmis" 3 => "T. Degroote" 4 => "M. Tran" 5 => "C. Bruel" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jcrc.2018.12.005" "Revista" => array:6 [ "tituloSerie" => "J Crit Care" "fecha" => "2019" "volumen" => "50" "paginaInicial" => "155" "paginaFinal" => "161" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30551046" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735727/0000004800000004/v1_202403290634/S2173572723002035/v1_202403290634/en/main.assets" "Apartado" => array:4 [ "identificador" => "64268" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letter to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735727/0000004800000004/v1_202403290634/S2173572723002035/v1_202403290634/en/main.pdf?idApp=WMIE&text.app=https://medintensiva.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572723002035?idApp=WMIE" ]
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