Effect of oropharyngeal povidone-iodine preventive oral care on ventilator-associated pneumonia in severely brain-injured or cerebral hemorrhage patients: a multicenter, randomized controlled trial.

Philippe Seguin 1, * Bruno Laviolle 2, 3 Claire Dahyot-Fizelier 4 Romain Dumont 5 Benoit Veber 6 Soizic Gergaud 7 Karim Asehnoune 5 Olivier Mimoz 8 Pierre-Yves Donnio 9 Eric Bellissant 2, 3 Yannick Malledant 1
* Corresponding author
1 Foie, métabolismes et cancer
2 CIC - Centre d'Investigation Clinique [Rennes]
3 Service de Pharmacologie
4 Pharmacologie des anti-infectieux
5 Service d'Anesthésie-Réanimation [CHU Limoges]
6 Service de réanimation médicale [Rouen]
7 Service d'anesthésie et réanimation chirurgicale
8 Pharmacologie des anti-infectieux
9 Unité de contrôle infectieux
Abstract : OBJECTIVE: To evaluate the efficacy and safety of oral care with povidone-iodine on the occurrence of ventilator-associated pneumonia in a high-risk population. DESIGN: A multicenter, placebo-controlled, randomized, double-blind, two-parallel-group trial performed between May 2008 and May 2011. SETTING: Six ICUs in France. PATIENTS: One hundred seventy-nine severely brain-injured patients (Glasgow Coma Scale ≤ 8) or cerebral hemorrhage expected to be mechanically ventilated for more than 24 hours. INTERVENTIONS: Participants were randomly assigned to receive oropharyngeal care with povidone-iodine (n = 91) or placebo (n = 88) six times daily until mechanical ventilation withdrawal. MEASUREMENTS AND MAIN RESULTS: Primary endpoint was the rate of ventilator-associated pneumonia. Secondary endpoint included the rates of ventilator-associated tracheobronchitis and acute respiratory distress syndrome and patient's outcome. The number of patients evaluable for the primary endpoint (preplanned modified intention-to-treat population) was 150 (78 in the povidone-iodine group, 72 in the placebo group). Ventilator-associated pneumonia occurred in 24 patients (31%) in the povidone-iodine group and 20 (28%) in the placebo group (relative risk, 1.11 [95% CI, 0.67-1.82]; p = 0.69). There was no significant difference between the two groups for ventilator-associated tracheobronchitis: eight patients (10%) in the povidone-iodine group and five patients (7%) in the placebo group (relative risk, 1.48 [95% CI, 0.51-4.31]; p = 0.47). Acute respiratory distress syndrome occurred in five patients in the povidone-iodine group but not in the placebo group (p = 0.06). There was no difference between groups for ICU and hospital lengths of stay, as well as ICU and 90-day mortality. CONCLUSIONS: There is no evidence to recommend oral care with povidone-iodine to prevent ventilator-associated pneumonia in high-risk patients. Furthermore, this strategy seems to increase the rate of acute respiratory distress syndrome.
keyword : intensive care medicine oral care povidone-iodine prevention ventilator-associated pneumonia
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Journal articles
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https://hal-univ-rennes1.archives-ouvertes.fr/hal-00933163
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Submitted on : Monday, January 20, 2014 - 9:46:37 AM
Last modification on : Thursday, July 25, 2019 - 2:24:50 PM

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UNIV-POITIERS | CIC203 | CIC | UNIV-RENNES1 | BIOSIT | NUMECAN | NUMECAN-EXPRES | UR1-UFR-SVE | UNIV-RENNES | COMUE-NORMANDIE | UNIROUEN | UNAM

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Philippe Seguin, Bruno Laviolle, Claire Dahyot-Fizelier, Romain Dumont, Benoit Veber, et al.. Effect of oropharyngeal povidone-iodine preventive oral care on ventilator-associated pneumonia in severely brain-injured or cerebral hemorrhage patients: a multicenter, randomized controlled trial.. Critical Care Medicine, Lippincott, Williams & Wilkins, 2014, 42 (1), pp.1-8. ⟨10.1097/CCM.0b013e3182a2770f⟩. ⟨hal-00933163⟩

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