A Study Comparing a Suspension of Lactobacillus Plantarum 299 With Chlorhexidine for Oral Care in Intubated Mechanically Ventilated Patients in Intensive Care
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 发起方
- Region Skane
- 入组人数
- 100
- 试验地点
- 6
- 主要终点
- Recovery of Lactobacillus plantarum 299 in tracheal secretions in the active treatment group as an indicator of aspiration
研究概览
简要总结
Critically ill patients often need ventilatory support through a plastic tube connected to a ventilator. Those patients have a altered microbiological flora in the mouth, oropharynx as well as throughout the intestine. Bacteria that can cause illness are often found in the oropharynx in such patients and measures are taken in order to reduce the risk of secondary infections by those bacteria. In all intensive care patients oral care is provided by the nursing staff aiming at a reduction of the pathogenic species. This is done by a variety measures.
Chlorhexidine (CHX) is an antisepticum with a capability to reduce bacterial counts in the mouth and oropharynx and has been shown to be of value also for intubated patients. It is used frequently throughout the world.
Ventilator-associated pneumonia (VAP) is a costly rather frequent complication to intensive care and mechanical ventilation and is usually caused by aspiration of infected secretions from the oropharynx. CHX has in some studies been shown to reduce the frequency of VAP.
The probiotic bacterium Lactobacillus plantarum 299 has the ability to adhere to the mucosa throughout the gastro-intestinal tract including the mouth and in our pilot study we found that L plantarum had better ability to reduce colonisation with enteric bacteria in the oropharynx than CHX had. Figures not statistical significant so this present study is aiming to get a larger amount of data.
The procedure was found to be safe Hypothesis: Lactobacillus plantarum is better than CHX for the reduction of pathogenic bacteria in the oropharynx in intubated mechanically ventilated patients and consequently has a better potential to reduce the frequency of VAP
详细描述
This study is an expansion of a pilot study performed at the ICU Lund University Hospital, Sweden where 50 patients were included (ISRCTN00472141).
Results have been published in Critical Care 2008, 12:R136 The protocol is the same and in this second phase we intend to include 100 patients and results will be summed up.
Three centres are engaged. The results from the pilot study is encouraging and we are aiming at getting statistical significance in the differences in pathogenic findings in the cultures from oropharynx and also better a better basis for the calculation of the number of patients needed to get sufficient power to study difference in VAP frequency.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Prevention
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •18 years or older
- •Critically ill patients anticipated to require mechanical ventilation for at least 24 hours
排除标准
- •Pneumonia as admission diagnosis,
- •Fractures on the facial skeleton or the skull base;
- •Known ulcers in the oral cavity, the oropharynx, or the esophagus
- •Known immune difficency
- •Carrier of HIV or Hepatitis
- •Patient being moribund
结局指标
主要结局
Recovery of Lactobacillus plantarum 299 in tracheal secretions in the active treatment group as an indicator of aspiration
时间窗: During study time in connection with the care in the ICU until invasive mechanical ventilation is terminated
To compare the number and frequency of cultures with pathogenic bacteria and fungi from the oropharynx and tracheal secretions and the spectra of these microbiological species
时间窗: During study time in connection with the care in the ICU until invasive mechanical ventilation is terminated
次要结局
- Difference in emerge of Ventilator Associated Pneumonia(During ICU stay)
- 28 day mortality(28 days after ICU admission)
- SOFA score and Influence on lung function measured as Lung Injury Severity Score(From admission to the ICU til discharge from the ICU)
- C-reactive protein and white blood cell counts(From admission to the ICU til discharge from the ICU)
- Validation of micobiological findings compared to the use of antibiotics(ICU stay + 48 hours)
- Evaluation of microbiological cultures taken on clinical grounds(ICU-stay + 48 hours)
- 6 months mortality(6 months after ICU admission)