In this episode, I’ll discuss a yet-to-be-published study of chlorhexidine for oral hygiene in ICU patients.
In recent years, the journal Intensive Care Medicine has published a cohort study and editorial that call into question the safety and efficacy of oral mouth care with chlorhexidine in ventilated ICU patients. Concerns include the risk of bias in the studies that have been used to justify oral care with chlorhexidine and the possibility that chlorhexidine may have direct negative effects on oral mucosa.
Since the beginning of 2018, a large 4000+ patient randomized controlled trial has been underway looking at the De-adoption of Oral Chlorhexidine Prophylaxis and Implementation of an Oral Care Bundle for Ventilated Critically Ill Patients. It is clear from the design of the study that the authors recognize the importance of oral hygiene in ventilated ICU patients, as the control group includes a robust oral care bundle but excludes the use of chlorhexidine.
While the results of this study have not yet been published, the two principal investigators have co-authored another editorial in Intensive Care Medicine titled Less daily oral hygiene is more in the ICU: yes. The authors repeat the previous concerns about study quality and adverse effect profile, and make the following argument:
Applying oral chlorhexidine is not the same as good oral care, in fact, it may be bad oral care. We need to stop conflating chlorhexidine application with good oral care. Good oral care (excluding oral chlorhexidine) is to be commended and recommended to relieve the severe symptoms suffered by critically ill patients and prevent dental disease. The state of the evidence base at this time suggest that we should place a moratorium on the use of oral chlorhexidine until high quality randomized trials have reported.
The high-quality randomized trial they reference is of course their own. While there is no information on the timeline until results are published, it is already past the time study completion was scheduled to occur by. My guess is the investigators would not write this article if they did not have some idea of the results of their trial so far. I’ll continue to keep an eye out for the results and share them on the podcast when they are available.
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