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Intensive Care Medicine
Erschienen in:

18.04.2018 | Seven-Day Profile Publication

Oropharyngeal and nasopharyngeal decontamination with chlorhexidine gluconate in lung cancer surgery: a randomized clinical trial

verfasst von: Xavier Benoit D’Journo, Pierre-Emmanuel Falcoz, Marco Alifano, Jean-Philippe Le Rochais, Thomas D’Annoville, Gilbert Massard, Jean Francois Regnard, Philippe Icard, Charles Marty-Ane, Delphine Trousse, Christophe Doddoli, Bastien Orsini, Sophie Edouard, Matthieu Million, Nathalie Lesavre, Anderson Loundou, Karine Baumstarck, Florence Peyron, Stephane Honoré, Stéphanie Dizier, Aude Charvet, Marc Leone, Didier Raoult, Laurent Papazian, Pascal Alexandre Thomas

Erschienen in: Intensive Care Medicine | Ausgabe 5/2018

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Abstract

Purpose

Respiratory complications are the leading causes of morbidity and mortality after lung cancer surgery. We hypothesized that oropharyngeal and nasopharyngeal decontamination with chlorhexidine gluconate (CHG) would be an effective method to reduce these complications as reported in cardiac surgery.

Methods

In this multicenter parallel-group randomized double-blind placebo-controlled trial, we enrolled consecutive adults scheduled for anatomical pulmonary resection for lung cancer. Perioperative decontamination consisted in oropharyngeal rinse solution (0.12% CHG) and nasopharyngeal soap (4% CHG) or a placebo. The primary outcome measure was the proportion of patients requiring postoperative invasive and/or noninvasive mechanical ventilation (MV). Secondary outcome measures included occurrence of respiratory and non-respiratory healthcare-associated infections (HAIs) and outcomes within 90 days.

Results

Between July 2012 and April 2015, 474 patients were randomized. Of them, 24 had their surgical procedure cancelled or withdrew consent. The remaining 450 patients were included in a modified intention-to-treat analysis: 226 were allocated to CHG and 224 to the placebo. Proportions of patients requiring postoperative MV were not significantly different [CHG 14.2%; placebo 15.2%; relative risks (RRs) 0.93; 95% confidence interval (CI) 0.59–1.45; P = 0.76]. Neither of the proportions of patients with respiratory HAIs were different (CHG 13.7%; placebo 12.9%; RRs 1.06; 95% CI 0.66–1.69; P = 0.81). The CHG group had significantly decreased incidence of bacteremia, surgical-site infection and overall Staphylococcus aureus infections. However, there were no significant between-group differences for hospital stay length, change in tracheal microbiota, postoperative antibiotic utilization and outcomes by day 90.

Conclusions

CHG decontamination decreased neither MV requirements nor respiratory infections after lung cancer surgery. Additionally, CHG did not change tracheal microbiota or postoperative antibiotic utilization.

Trial Registration

This study is registered on ClinicalTrials.gov, number NCT01613365.
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Metadaten
Titel
Oropharyngeal and nasopharyngeal decontamination with chlorhexidine gluconate in lung cancer surgery: a randomized clinical trial
verfasst von
Xavier Benoit D’Journo
Pierre-Emmanuel Falcoz
Marco Alifano
Jean-Philippe Le Rochais
Thomas D’Annoville
Gilbert Massard
Jean Francois Regnard
Philippe Icard
Charles Marty-Ane
Delphine Trousse
Christophe Doddoli
Bastien Orsini
Sophie Edouard
Matthieu Million
Nathalie Lesavre
Anderson Loundou
Karine Baumstarck
Florence Peyron
Stephane Honoré
Stéphanie Dizier
Aude Charvet
Marc Leone
Didier Raoult
Laurent Papazian
Pascal Alexandre Thomas
Publikationsdatum
18.04.2018
Verlag
Springer Berlin Heidelberg
Erschienen in
Intensive Care Medicine / Ausgabe 5/2018
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-018-5156-2

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