Oropharyngeal antisepsis in the critical patient and in the patient subjected to mechanical ventilation

Abstract

Lower respiratory tract infections in the intubated patient constitute a serious health problem due to their associated morbidity and mortality. Microaspiration of the buccopharyngeal secretions is the main physiopathological mechanism underlying the development of pneumonia and tracheobronchitis in intubated patients. All care bundles designed to prevent these infections include the use of antiseptics to reduce buccopharyngeal colonization. Chlorhexidine is the antiseptic most frequently assessed in clinical trials and meta-analyses that conclude that oral hygiene with chlorhexidine reduces the incidence of ventilator-associated pneumonia - maximum effectiveness being achieved when the product is administered at a concentration of 2%. However, 2meta-analyses have warned of a possible increase in mortality when chlorhexidine is used as an oral antiseptic. We therefore recommend its use but with extreme caution during application in order to avoid aspiration of the antiseptic. This article is part of a supplement entitled "Antisepsis in the critical patient", which is sponsored by Becton Dickinson.

Keywords: Antisepsia; Antisepsis; Critical patient; Mechanical ventilation; Paciente crítico; Ventilación mecánica.