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Intensive Care Medicine May 2018, Volume 44, Issue 5, pp 578–587| Cite as Oropharyngeal and nasopharyngeal decontamination with chlorhexidine gluconate in lung cancer surgery: a randomized clinical trial Authors
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 Xavier Benoit D’JournoPierre-Emmanuel FalcozMarco AlifanoJean-Philippe Le RochaisThomas D’AnnovilleGilbert MassardJean Francois RegnardPhilippe IcardCharles Marty-AneDelphine TrousseChristophe DoddoliBastien OrsiniSophie EdouardMatthieu MillionNathalie Lesavreshow 10 more

Seven-Day Profile Publication First Online: 18 April 2018 5
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Citations Abstract Purpose Respiratory complications are the leading causes of morbidity and mortality after lung cancer surgery. We hypothesized that oropharyngeal and nasopharyngeal decontamination with chlorhexidine gluconate (CHG) would be an effective method to reduce these complications as reported in cardiac surgery. Methods In this multicenter parallel-group randomized double-blind placebo-controlled trial, we enrolled consecutive adults scheduled for anatomical pulmonary resection for lung cancer. Perioperative decontamination consisted in oropharyngeal rinse solution (0.12% CHG) and nasopharyngeal soap (4% CHG) or a placebo. The primary outcome measure was the proportion of patients requiring postoperative invasive and/or noninvasive mechanical ventilation (MV). Secondary outcome measures included occurrence of respiratory and non-respiratory healthcare-associated infections (HAIs) and outcomes within 90 days. Results Between July 2012 and April 2015, 474 patients were randomized. Of them, 24 had their surgical procedure cancelled or withdrew consent. The remaining 450 patients were included in a modified intention-to-treat analysis: 226 were allocated to CHG and 224 to the placebo. Proportions of patients requiring postoperative MV were not significantly different [CHG 14.2%; placebo 15.2%; relative risks (RRs) 0.93; 95% confidence interval (CI) 0.59–1.45; P = 0.76]. Neither of the proportions of patients with respiratory HAIs were different (CHG 13.7%; placebo 12.9%; RRs 1.06; 95% CI 0.66–1.69; P = 0.81). The CHG group had significantly decreased incidence of bacteremia, surgical-site infection and overall Staphylococcus aureusinfections. However, there were no significant between-group differences for hospital stay length, change in tracheal microbiota, postoperative antibiotic utilization and outcomes by day 90. Conclusions CHG decontamination decreased neither MV requirements nor respiratory infections after lung cancer surgery. Additionally, CHG did not change tracheal microbiota or postoperative antibiotic utilization. Trial Registration This study is registered on ClinicalTrials.gov, number NCT01613365. Keywords Lung cancer Surgery Infection Chlorhexidine gluconate Video-assisted thoracic surgery Pneumonia Mechanical ventilation Noninvasive ventilation Hospital-acquired infection  Electronic supplementary material The online version of this article ( https://doi.org/10.1007/s00134-018-5156-2) contains supplementary material, which is available to authorized users. This is a preview of subscription content, log in to check access. Notes Acknowledgment Antoinette Wolff is acknowledged for critical revision of the manuscript and for English language editing. Fleur Petit, Christelle Grangier, Patrick Sudour, and Alexandra Giuliani are acknowledged for their administrative support. All the pharmacy and research department staff of the five centers are also acknowledged. Compliance with ethical standards Conflict of interest On behalf of all authors, the corresponding author states that there is no conflict of interest. Funding This trial was funded by the French Programme Hospitalier de Recherche Clinique (PHRC) no. 2011-004536-63 and Assistance-Publique Hôpitaux de Marseille-Aix-Marseille Université. The study funders had no role in the design, the conduct, the collection, the analysis, and the interpretation of the data. They had also no role in preparation, review, approval, and decision to submit the manuscript for publication.