Strategies To Prevent Pneumonia 2 (SToPP2)

Ventilator-associated pneumonia (VAP) is an acute care complication with high morbidity and
mortality, which is costly in length of stay and resources used. Application of
chlorhexidine (CHX) to the mouths of critically ill adults after intubation reduces risk of
VAP. During intubation, organisms may be dragged by the tube from the contaminated mouth to
the sterile lung, and the endotracheal tube (ET) provides a pathway for direct entry of
bacteria from the mouth to the lower respiratory tract. However, procedures to decontaminate
the mouth before intubation are not routine and little is known about the effects of
pre-intubation CHX in critically ill patients. Thus, this project focuses on evaluating the
benefit of adding a pre-intubation CHX dose to the known benefit of post-intubation CHX to
reduce the risk of VAP. In order to examine the effect of pre-intubation CHX on early ET
colonization, we will perform microbial cultures of ETs of subjects who are extubated in the
first 24 hours of study participation. We will also explore selected biomarkers
(procalcitonin, cytokines) as indicators of development of VAP in a subset of subjects. The
project will add to knowledge about the relationships among oral health, ET intubation and
VAP, and addresses an important clinical outcome. Pre-intubation oral decontamination could
reduce risk of VAP and its associated morbidity and mortality.

Inclusion Criteria:

- Need for intubation

Exclusion Criteria:

- Pneumonia at the time of intubation