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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 aureus infections. 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., Author(s): Xavier Benoit D'Journo [sup.1] [sup.6], Pierre-Emmanuel Falcoz [sup.2], Marco Alifano [sup.3], Jean-Philippe Le Rochais [sup.4], Thomas D'Annoville [sup.5], Gilbert Massard [sup.2], Jean Francois Regnard [sup.3], Philippe Icard [sup.4], Charles [...]

Byline: Aurelie Lefebvre (1), Christine Lorut (1), Marco Alifano (2), Herve Dermine (3), Nicolas Roche (1), Remy Gauzit (3), Jean-Francois Regnard (2), Gerard Huchon (1), Antoine Rabbat (1,4) Keywords: Noninvasive ventilation; Acute respiratory failure; Postoperative thoracic surgery; Lung resection; COPD; Outcomes Abstract: Background A single prospective randomized study found that, in selected patients with acute respiratory failure (ARF) following lung resection, noninvasive ventilation (NIV) decreases the need for endotracheal mechanical ventilation and improves clinical outcome. Method We prospectively evaluated early NIV use for ARF after lung resection during a 4-year period in the setting of a medical and a surgical ICU of a university hospital. We documented demographics, initial clinical characteristics and clinical outcomes. NIV failure was defined as the need for tracheal intubation. Results Among 690 patients at risk of severe complications following lung resection, 113 (16.3%) experienced ARF, which was initially supported by NIV in 89 (78.7%), including 59 with hypoxemic ARF (66.3%) and 30 with hypercapnic ARF (33.7%). The overall success rate of NIV was 85.3% (76/89). In-ICU mortality was 6.7% (6/89). The mortality rate following NIV failure was 46.1%. Predictive factors of NIV failure in univariate analysis were age (P = 0.046), previous cardiac comorbidities (P = 0.0075), postoperative pneumonia (P = 0.0016), admission in the surgical ICU (P = 0.034), no initial response to NIV (P < 0.0001) and occurrence of noninfectious complications (P = 0.037). Only two independent factors were significantly associated with NIV failure in multivariate analysis: cardiac comorbidities (odds ratio, 11.5 95% confidence interval, 1.9--68.3 P = 0.007) and no initial response to NIV (odds ratio, 117.6 95% confidence interval, 10.6--1305.8 P = 0.0001). Conclusion This prospective survey confirms the feasibility and efficacy of NIV in ARF following lung resection. Author Affiliation: (1) Department of Respiratory and Intensive Care Medicine, Hotel-Dieu Hospital, AP-HP, Universite Paris 5, Rene Descartes, Paris, France (2) Department of Thoracic Surgery, Hotel-Dieu Hospital, AP-HP, Universite Paris 5, Rene Descartes, Paris, France (3) Department of Anesthesiology and Surgical Intensive Care, Hotel-Dieu Hospital, AP-HP, Universite Paris 5, Rene Descartes, Paris, France (4) Pneumologie et Reanimation, Hotel-Dieu, 1, place du parvis de Notre-Dame, 75181, Paris Cedex 04, France Article History: Registration Date: 01/10/2008 Received Date: 08/04/2008 Accepted Date: 26/09/2008 Online Date: 14/10/2008 Article note: This work was presented during the September 2008 ESICM congress in Lisbon international meeting and published as an abstract. Electronic supplementary material The online version of this article (doi: 10.1007/s00134-008-1317-z) contains supplementary material, which is available to authorized users.

Author(s): Marco Alifano [sup.1] [sup.4], Christine Lorut [sup.2] [sup.4], Aurelie Lefebvre [sup.2] [sup.4], Lyna Khattar [sup.2] [sup.4], Diane Damotte [sup.3] [sup.4], Gerard Huchon [sup.2] [sup.4], Jean-Francois Regnard [sup.1] [sup.4], Antoine [...]