Uso de clorexidina 2% gel e escova o mecanica na higiene bucal de pacientes sob ventila o mecanica: efeitos na pneumonia associada a ventilador The use of 2% chlorhexidine gel and toothbrushing for oral hygiene of patients receiving mechanical ventilation: effects on ventilator-associated pneumonia

OBJETIVO: Avaliar os efeitos da higiene bucal com clorexidina 2% e escova o mecanica sobre a taxa de pneumonia associada a ventilador em uma popula o mista de pacientes sob ventila o mecanica prolongada. MéTODOS: Estudo piloto prospectivo, aleatório e placebo-controlado. Foram incluídos pacientes sob ventila o mecanica, com menos de 24 horas de interna o e cuja perspectiva de dura o da ventila o mecanica era a de um período >72 horas. Os pacientes foram randomizados para o grupo clorexidina (gel com clorexidina a 2%) e escova o mecanica ou grupo placebo (gel da mesma colora o e consistência e escova o mecanica) na higiene bucal. RESULTADOS: A análise interina planejada foi realizada quando 52 pacientes foram incluídos, e o estudo foi interrompido precocemente. Um total de 28 pacientes foi incluído no grupo clorexidina/escova o mecanica e 24 no grupo placebo. As taxas de pneumonia associada a ventilador foram de 45,8% no grupo placebo e de 64,3% no grupo clorexidine/escova o mecanica (RR=1,4; IC95%=0,83-2,34;p=0,29). CONCLUS O: Devido a interrup o precoce por futilidade, n o foi possível avaliar o impacto do uso de clorexidina a 2% e escova o mecanica na higiene bucal na incidência de pneumonia associada a ventilador nessa popula o heterogênea de pacientes críticos sob ventila o mecanica prolongada, n o tendo sido evidenciado nenhum efeito benéfico dessa interven o. OBJECTIVE: To evaluate the effects of oral chlorhexidine hygiene with toothbrushing on the rate of ventilator-associated pneumonia in a mixed population of critically ill patients under prolonged mechanical ventilation. METHODS: Prospective, randomized, and placebo-controlled pilot study. Patients who were receiving mechanical ventilation, had been admitted less than 24 hours prior, and were anticipated to require mechanical ventilation for more than 72 hours were included in the study. The patients were randomly divided into one of the following groups: chlorhexidine hygiene with toothbrushing or a placebo group (gel with the same color and consistency and toothbrushing). RESULTS: The planned interim analysis was conducted using 52 patients, and the study was terminated prematurely. In total, 28 patients were included in the chlorhexidine / toothbrushing group, and 24 patients were included in the placebo group. Ventilator-associated pneumonia occurred in 45.8% of the placebo group and in 64.3% of the chlorhexidine hygiene with toothbrushing group (RR=1.4; 95% CI=0.83-2.34; p=0.29). CONCLUSION: Because the study was terminated due to futility, it was not possible to evaluate