{"id":20606,"date":"2021-11-11T05:00:00","date_gmt":"2021-11-10T21:00:00","guid":{"rendered":"http:\/\/csccm.org.cn\/?p=20606"},"modified":"2021-11-11T05:50:07","modified_gmt":"2021-11-10T21:50:07","slug":"intensive-care-med%e5%8f%91%e8%a1%a8%e8%ae%ba%e6%96%87%ef%bc%9a%e4%b8%8d%e4%bd%bf%e7%94%a8%e6%b4%97%e5%bf%85%e6%b3%b0%e6%bc%b1%e5%8f%a3%e4%bb%a5%e5%8f%8a%e5%ae%9e%e6%96%bd%e5%8f%a3%e8%85%94%e9%9b%86","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=20606","title":{"rendered":"[Intensive Care Med\u53d1\u8868\u8bba\u6587]\uff1a\u4e0d\u4f7f\u7528\u6d17\u5fc5\u6cf0\u6f31\u53e3\u4ee5\u53ca\u5b9e\u65bd\u53e3\u8154\u96c6\u675f\u5316\u62a4\u7406\u5bf9\u673a\u68b0\u901a\u6c14\u60a3\u8005\u75c5\u6b7b\u7387\u7684\u5f71\u54cd"},"content":{"rendered":"\n<h1 class=\"wp-block-heading\">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<\/h1>\n\n\n\n<h3 class=\"wp-block-heading\">Craig M. Dale,\u00a0Louise Rose,\u00a0Sarah Carbone, et al<\/h3>\n\n\n\n<h3 class=\"wp-block-heading\">Intensive Care Med <a href=\"https:\/\/link.springer.com\/article\/10.1007\/s00134-021-06475-2#article-info\">Published:\u00a0<time datetime=\"2021-10-05\">05 October 2021<\/time><\/a><\/h3>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"Abs1\">Abstract<\/h2>\n\n\n\n<h3 class=\"wp-block-heading\">Purpose<\/h3>\n\n\n\n<p>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.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Methods<\/h3>\n\n\n\n<p>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.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Results<\/h3>\n\n\n\n<p>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;&nbsp;<em>P<\/em>\u2009=\u20090.46). Time to IVACs (adjusted hazard ratio [aHR], 1.06; 95% CI 0.44 to 2.57;&nbsp;<em>P<\/em>\u2009=\u20090.90), time to extubation (aHR 1.03; 95% CI 0.85 to 1.23;&nbsp;<em>P<\/em>\u2009=\u20090.79) (survivors) and oral procedural pain (aOR, 0.62; 95% CI 0.34 to 1.10;&nbsp;<em>P<\/em>\u2009=\u20090.10) were similar between control and intervention periods. However, oral health dysfunction scores (\u2212\u20090.96; 95% CI\u2009\u2212\u20091.75 to\u2009\u2212\u20090.17;&nbsp;<em>P<\/em>\u2009=\u20090.02) improved in the intervention period.<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/media.springernature.com\/full\/springer-static\/image\/art%3A10.1007%2Fs00134-021-06475-2\/MediaObjects\/134_2021_6475_Fig1_HTML.png?as=webp\" alt=\"\"\/><\/figure>\n\n\n\n<h3 class=\"wp-block-heading\">Conclusion<\/h3>\n\n\n\n<p>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.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Effect of oral chlorhexidine de-adoption and implementa [&hellip;]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[32,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/20606"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=20606"}],"version-history":[{"count":1,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/20606\/revisions"}],"predecessor-version":[{"id":20607,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/20606\/revisions\/20607"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=20606"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=20606"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=20606"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}