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NCT Number: NCT01105819

Chlorhexidine vs Lactobacillus Plantarum for Oral Care in Intubated ICU Patients

Critically ill patients often need ventilatory support through a plastic tube connected to a ventilator. Those patients have a altered microbiological flora in the mouth, oropharynx as well as throughout the intestine. Bacteria that can cause illness are often found in the oropharynx in such patients and measures are taken in order to reduce the risk of secondary infections by those bacteria. In all intensive care patients oral care is provided by the nursing staff aiming at a reduction of the pathogenic species. This is done by a variety measures.

Chlorhexidine (CHX) is an antisepticum with a capability to reduce bacterial counts in the mouth and oropharynx and has been shown to be of value also for intubated patients. It is used frequently throughout the world.

Ventilator-associated pneumonia (VAP) is a costly rather frequent complication to intensive care and mechanical ventilation and is usually caused by aspiration of infected secretions from the oropharynx. CHX has in some studies been shown to reduce the frequency of VAP.

The probiotic bacterium Lactobacillus plantarum 299 has the ability to adhere to the mucosa throughout the gastro-intestinal tract including the mouth and in our pilot study we found that L plantarum had better ability to reduce colonisation with enteric bacteria in the oropharynx than CHX had. Figures not statistical significant so this present study is aiming to get a larger amount of data.

The procedure was found to be safe Hypothesis: Lactobacillus plantarum is better than CHX for the reduction of pathogenic bacteria in the oropharynx in intubated mechanically ventilated patients and consequently has a better potential to reduce the frequency of VAP

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Key information

Conditions

Pathogenic Bacteria in the Oropharynx Cross Infection Disease Attributes Healthcare-Associated Pneumonia Iatrogenic Disease Infections Lung Diseases Pathologic Processes Pathological Conditions, Signs and Symptoms Pneumonia Pneumonia, Ventilator-Associated Respiratory Tract Diseases Respiratory Tract Infections Ventilator-associated Pneumonia

Age range

18 year and older

Sex eligibility

All sexes

Study type

Interventional

Phase

Not applicable

Primary location

Intensive Care Unit, Halmstad Central Hospital, Halmstad, Sweden

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About this study

This study is an expansion of a pilot study performed at the ICU Lund University Hospital, Sweden where 50 patients were included (ISRCTN00472141).

Results have been published in Critical Care 2008, 12:R136 The protocol is the same and in this second phase we intend to include 100 patients and results will be summed up.

Three centres are engaged. The results from the pilot study is encouraging and we are aiming at getting statistical significance in the differences in pathogenic findings in the cultures from oropharynx and also better a better basis for the calculation of the number of patients needed to get sufficient power to study difference in VAP frequency.

Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

  • 18 years or older
  • Critically ill patients anticipated to require mechanical ventilation for at least 24 hours

Exclusion criteria

  • Pneumonia as admission diagnosis,
  • Fractures on the facial skeleton or the skull base;
  • Known ulcers in the oral cavity, the oropharynx, or the esophagus
  • Known immune difficency
  • Carrier of HIV or Hepatitis
  • Patient being moribund

Treatment and study plan

Lactobacillus plantarum 299 for oral care

Procedure

The study group will be attended in the same manor but the swabs used for cleansing are soaked with carbonated water directly from freshly opened bottles. As the final part of the procedure oral mucosal surfaces are pencilled with a suspension of the probiotic bacterium Lactobacillus plantarum 299 Cultures from the oropharynx and tracheal secretions are taken at inclusion (day 1) and then on days 2,3,5,7,10,14 and 21 or before extubation if this occurs on a non-culture day

Chlorhexidine for standard oral care

Procedure

A The control group will receive the standard oral care of the department (general ICU, Lund University Hospital).

This includes suction of secretions, brushing of teeth cleansing of the oral cavity with swabs soaked with a chlorhexidine solution. This procedure is performed twice a day. In between, suction whenever needed and cleansing with swabs soaked with carbonated bottled water is performed Cultures from the oropharynx and tracheal secretions are taken at inclusion (day 1) and then on days 2,3,5,7,10,14 and 21 or before extubation if this occurs on a non-culture day

Primary outcomes

  1. To compare the number and frequency of cultures with pathogenic bacteria and fungi from the oropharynx and tracheal secretions and the spectra of these microbiological species

    Time frame: During study time in connection with the care in the ICU until invasive mechanical ventilation is terminated

  2. Recovery of Lactobacillus plantarum 299 in tracheal secretions in the active treatment group as an indicator of aspiration

    Time frame: During study time in connection with the care in the ICU until invasive mechanical ventilation is terminated

Secondary outcomes

  1. SOFA score and Influence on lung function measured as Lung Injury Severity Score

    Time frame: From admission to the ICU til discharge from the ICU

  2. Difference in emerge of Ventilator Associated Pneumonia

    Time frame: During ICU stay

  3. Validation of micobiological findings compared to the use of antibiotics

    Time frame: ICU stay + 48 hours

  4. C-reactive protein and white blood cell counts

    Time frame: From admission to the ICU til discharge from the ICU

  5. Evaluation of microbiological cultures taken on clinical grounds

    Time frame: ICU-stay + 48 hours

    We want to examine the possible influence of the added probioticum on the frequence of positive cultures from other sites than those taken per protocol.

    Samples taken during ICU-stay and 48 hours after discharge from the ICU will be examened The type of species in positive cultures are also of interest. Blood cultures may act as indicator of vascular spread of the studied bacterium.

    According to the protocol samples for blood cultures are not taken

  6. 28 day mortality

    Time frame: 28 days after ICU admission

  7. 6 months mortality

    Time frame: 6 months after ICU admission

Sponsors and collaborators

Lead sponsor

Region Skane

Other

Collaborators

  • County Council of Halland, Sweden
  • Probi AB

Registry information

Official study title

A Study Comparing a Suspension of Lactobacillus Plantarum 299 With Chlorhexidine for Oral Care in Intubated Mechanically Ventilated Patients in Intensive Care

Important dates

Study start
2010
Primary completion
2016
Study completion
2018
First posted
Apr 19, 2010
Registry last updated
May 17, 2018

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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