ICU中选择性口腔去污染（SOD）作用

      Abstruct: Ventilator-associated pneumonia (VAP) is a common cause of morbidity, antibiotic use, increased length of stay and, possibly,increased mortality in ICU patients. Colonization of the oropharyngeal cavity with potentially pathogenic micro-organisms is instrumental in the pathogenesis of VAP, and selective oropharyngeal decontamination (SOD) with antibiotics (AB-SOD) or antiseptics,such as chlorhexidine gluconate (CHX-SOD), has been associated with reduced incidences of VAP. In a recent issue of Critical Care Scannapieco and colleagues investigated differences in oropharyngeal colonization between mechanically ventilated patients receiving oropharyngeal decontamination with 0.12% CHX-SOD either once or twice daily compared to placebo. CHX-SOD was associated with a reduction in Staphylococcus aureus colonization,but the study was underpowered to demonstrate a reduction in VAP incidence. We urgently need well-designed and adequately powered studies to evaluate the potential benefits of CHX-SOD on patient outcome in ICUs.

      In summary, the evidence that both AB-SOD and CHX-SOD reduce VAP incidence in ICU patients is accumulating. The optimal frequency and concentration for CHX-SOD remains to be demonstrated. From Scannapieco and colleagues’

study we can conclude that twice daily is not necessarily better than once daily, but maybe a four times daily regimen with 2% instead of 0.12% CHX does make a difference.What we need now are well-designed and adequately powered studies to evaluate the effects of these measures on length of ICU stay and survival. If these effects were demonstrated,CHX-SOD would offer a very cheap and (ecologically)safe infection prevention measure in patient populations  increasingly suffering from infections caused by AMRB.