In this episode, I’ll discuss why I think the journal Intensive Care Medicine is of high quality.
In episode 654 I discussed a study recently published in the journal Intensive Care Medicine about the effects of oral chlorhexidine vs an oral care bundle on mortality for mechanically ventilated patients in the ICU. While the study was informative, its publication tells us a great deal about the integrity of the Intensive Care Medicine journal, its editorial system, and the researchers involved.
Intensive Care Medicine is one of the official journals of the European Society of Intensive Care Medicine and is based in Germany.
Starting in 2018, the journal has run articles and editorials that have highlighted potential issues with chlorhexidine oral care in ventilated ICU patients. The main point of concern referenced by these articles was a 2014 systematic review and meta-analysis published in JAMA that found that chlorhexidine use does not affect patient-centered outcomes in patients receiving mechanical ventilation.
In 2018 the journal published a review article of chlorhexidine use in adult patients in the ICU that concluded oral care with chlorhexidine should be restricted until further data became available. Two editorials were published by the journal the same year titled Caution for chlorhexidine gluconate use for oral care: insufficient data and Oral care with chlorhexidine: beware!
With so many articles on the potential negative effects of oral care with chlorhexidine, the journal seemed heavily invested in this viewpoint.
The recently published randomized controlled trial on chlorhexidine use did not find the increased risk of mortality that so many articles in the journal had been concerned about. Rather it found no apparent benefit or harm to the intervention compared to a good oral care routine that included only twice-daily oral assessment and tooth brushing; mouth moisturization, and lip moisturization with additional secretion removal every 4 hours.
Some of the same authors of previous articles warning against using chlorhexidine were involved in this study. The desire to justify the viewpoints of previously published articles creates its own type of non-financial conflict of interest, and it would be easy for such a bias to creep into the presentation of this new article given the investment that the journal has shown in the viewpoint that oral care with chlorhexidine has potentially negative effects.
However, this article is presented in a neutral and fair manner – despite the outcome not matching the original hypothesis of the investigators. Such a neutral presentation could only be accomplished with a deliberate focus by the authors and editors on avoiding bias from prior viewpoints when presenting the new article.
To see such an outcome of this research demonstrates that the journal Intensive Care Medicine (both its editors and its authors) is committed to advancing practice in the area of intensive care based on how the evidence turns out without allowing even non-financial conflicts to interfere with the research process.
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