The effect of alkalinization of oral cavity by sodium bicarbonate mouth wash to decrease ventilator-associated pneumonia in traumatic brain injury patients: A prospective randomized controlled study

Abstract

Background: Traumatic brain injury is the leading cause of death and disability among trauma patients. They are often in need of mechanical ventilation and intensive care. Due to the lower immunity secondary to trauma, they acquire nosocomial infections quickly. Of them, ventilator-associated pneumonia (VAP) is very common. The microaspiration of the oral secretions containing the pathologic flora results in VAP. So, oral hygiene is of paramount importance. Various mouthwashes and rinses are available and are commonly used. We planned to compare the effectiveness of alkalization of oral cavity with 0.9% sodium bicarbonate on the incidence of VAP. Methods: After obtaining ethical committee clearance (IRB/Dean/2019/EC/1783) and written informed consent of the patient's attendants, one hundred eleven patients were randomized into two groups. Group CCC received 2% chlorhexidine mouth wash thrice daily whereas group CCS received 0.9% sodium bicarbonate oral rinse once with 2% chlorhexidine mouth wash twice daily. Our primary outcome was the incidence of VAP using the Clinical Pulmonary Infection Score (CPIS) from day one to day five. Comparison of Quantitative bacterial load and oral pH on day 1, day 3 and day 5 was our secondary outcome. Results: There was no statistical difference in the incidence of VAP among both groups from day one to day five (p > 0.05). We didn't find any difference in quantitative bacterial load among both groups on days one, three and five (p > 0.05). There was a statistical difference among both groups on oral pH on day three and day five with group CCS having higher oral pH than group CCC. (p = 0.03 on day 3 and 0.01 on day 5). Conclusion: The alkalization of oral cavity with 0.9% sodium bicarbonate oral rinse along with 2% chlorhexidine mouth wash lowered the incidence of VAP as compared to 2% chlorhexidine mouth wash alone but the difference was not statistically significant. © 2022 Elsevier Ltd