Chalmers, Sarah

Background Chlorhexidine is commonly used in prevention bundles for ventilator-associated pneumonia. Results for use of chlorhexidine in critically ill patients requiring mechanical ventilation via an endotracheal tube are mixed, and data for patients using a tracheostomy are lacking. Objectives To assess the risk for ventilator-associated pneumonia according to chlorhexidine exposure in patients requiring a new tracheostomy for mechanical ventilation. Methods This single-center, retrospective cohort study compared the development of ventilator-associated pneumonia according to chlorhexidine exposure in adult intensive care unit patients requiring new tracheostomy at a large academic medical center. Adults who received a new tracheostomy and required ventilator support for at least 48 hours were included. Patients treated for pneumonia at the time of tracheostomy or who met additional exclusion criteria were excluded. Results Of 235 patients who met the inclusion criteria, 203 received chlorhexidine and 32 did not. The cohort was predominantly White, male, and admitted to a surgical intensive care unit. Incidence of ventilator-associated pneumonia did not differ significantly between patients exposed or not to chlorhexidine (by 30 days, 32.5% vs 35.7%, P = .87). Time to development of ventilator-associated pneumonia also did not differ significantly between patients exposed or not (9 vs 12 days, respectively, P = .34). Conclusions Chlorhexidine exposure was not associated with a difference in the incidence of or time to ventilator-associated pneumonia after new tracheostomy. Further study is needed on the role of chlorhexidine in preventing ventilator-associated pneumonia after a new tracheostomy.