Objective: The objective of this article is to review the findings and discuss the implications of the effect of oral decontamination with chlorhexidine (CHX) or CHX/colistin on ventilator-associated pneumonia (VAP) incidence and time to development of VAP.

Design: This is a critical appraisal of the randomized, doubleblind, placebo-controlled trial: Koeman M, van der Ven AJ, Hak E, et al: Oral decontamination with chlorhexidine reduces the incidence of ventilator-associated pneumonia. Am J Respir Crit Care Med 2006; 173:1348 –1355.

Findings: This review finds that the study was adequately designed to examine the use of CHX in prevention of VAP. Patients were randomized and follow-up was complete. The results showed that the risk of early VAP (defined as within 48–96 hours) was reduced by 65% (hazards ratio 0.35, 95% confidence interval 0.16–0.79) for those treated with CHX and 55% (hazards ratio 0.45, 95% confidence interval 0.22– 0.93) for those treated with CHX/colistin compared with placebo. Intensive care unit (ICU) mortality, duration of mechanical ventilation, and lengths of ICU/ hospital stay were comparable for all three groups.

Conclusions: It is unclear whether the use of CHX as an oral decontaminant will be applicable to the pediatric intensive care unit population because the study was performed on adults with multiple comorbidities. It appears that the benefits of using CHX to prevent VAP outweigh the risks. But since the duration of ventilation and lengths of ICU/hospital stay were equivalent in each of the three groups, the use of CHX does not seem to impact morbidity and mortality. (Pediatr Crit Care Med 2009; 10:242–245)