Effect of Oral Hygiene with 0.12% Chlorhexidine Gluconate on the Incidence of Nosocomial Pneumonia in Children Undergoing Cardiac Surgery

Abstract

Objective.To evaluate the effect of oral hygiene with 0.12% Chlorhexidine gluconate on the incidence of nosocomial pneumonia and ventilator-associated pneumonia (VAP) in children undergoing cardiac surgery.Design.Prospective, randomized, double-blind, placebo-controlled trial.Setting.Pediatric intensive care unit (PICU) at a tertiary care hospital.Patients.One hundred sixty children undergoing surgery for congenital heart disease, randomized into 2 groups: Chlorhexidine (n= 87) and control (n= 73).Interventions.Oral hygiene with 0.12% Chlorhexidine gluconate or placebo preoperatively and twice a day postoperatively until PICU discharge or death.Results.Patients in experimental and control groups had similar ages (median, 12.2 vs 10.8 months;P= .72) and risk adjustment for congenital heart surgery 1 score distribution (66% in category 1 or 2 in both groups;P= .17). The incidence of nosocomial pneumonia was 29.8% versus 24.6% (P= .46) and the incidence of VAP was 18.3% versus 15% (P = .57) in the Chlorhexidine and the control group, respectively. There was no difference in intubation time (P= .34), need for reintubation (P= .37), time interval between hospitalization and nosocomial pneumonia diagnosis (P= .63), time interval between surgery and nosocomial pneumonia diagnosis (P= .10), and time on antibiotics (P= .77) and vasoactive drugs (P= .16) between groups. Median length of PICU stay (3 vs 4 days;P= .53), median length of hospital stay (12 vs 11 days;P= .67), and 28-day mortality (5.7% vs 6.8%;P= .77) were also similar in the Chlorhexidine and the control group.Conclusions.Oral hygiene with 0.12% Chlorhexidine gluconate did not reduce the incidence of nosocomial pneumonia and VAP in children undergoing cardiac surgery.Trial Registration.ClinicalTrials.gov identifier: NCT00829842.