Effect of chlorhexidine vs. saline for oral care on oral microbiota and prognosis of elderly mechanically ventilated patients in the intensive care unit: a single-center, single-blind, randomized controlled trial
Abstract
The role of chlorhexidine in oral care for mechanically ventilated elderly patients remains debated, particularly regarding its impact on oral microbiota and clinical outcomes. To compare oral microbiota composition and prognosis among elderly mechanically ventilated patients receiving oral care with either chlorhexidine solution or normal saline. Sixty intubated patients (≥ 65 years) were randomized to receive oral care with 0.12% chlorhexidine (intervention group) or 0.9% saline (control group) three times daily during mechanical ventilation. All patients underwent standardized oral hygiene during mechanical ventilation. Oral samples were analyzed by 16 S rRNA sequencing, with outcomes compared to oral health and clinical data. Secondary outcomes included dental plaque index, ventilator-associated pneumonia (VAP), 28-day mortality, patient outcomes, and oral complications. One week after intervention, the chlorhexidine group exhibited a significant decrease in oral bacterial diversity (Simpson index, P = 0.037). Despite this, no significant differences were observed in clinical infection symptoms-defined as fever, purulent airway secretions, elevated white blood cell count, or increased C-reactive protein levels requiring evaluation by the attending physician. All participants received standard ICU antimicrobial prophylaxis or therapy according to institutional protocols; no additional systemic antibiotics were initiated solely for oral or respiratory infections. There…
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Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design.
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