Usage Protocol Study of Calendula officinalis compared to Chlorhexidine in Oral Hygiene of Patients Admitted in the Intensive Care Unit
05 February 2020 (online)
Background: Pneumonia is defined as the presence of pulmonary infiltrate of infectious origin, with the onset of fever, purulent sputum, leukocytosis and oxygenation reduction. Ventilation-associated pneumonia (VAP) is the one that occurs after 48 h of endotracheal intubation and affects 9–27% of patients in the Intensive Care Unit (ICU). In order to prevent patients from developing VAP, intervention protocols were drafted. One of those was oral hygiene using chlorhexidine (CLX) as mouthwash at the concentration of 0.2% or 2%, the latter being more effective. Depending on the length of use and the concentration increase, the bacteria will develop resistance to CLX, while some studies show the use of Calendula officinalis (Cal off) as beneficial.
Aims: The present study aims to develop pharmaceutic gel formulations, using Cal off in 1 DH potency and CLX in 2% concentration, for further evaluation of their physicochemical, microbiological and biological response characteristics in ICU patients.
Methods: The two formulations were prepared according to the Brazilian Pharmacopeia (FB) 5th ed. and the Brazilian Homeopathic Pharmacopeia (FHB) 3rd ed. Stability studies were performed during their storage in a greenhouse, at room temperature or in a refrigerator, and according to appropriate standards.
Results and Conclusions: Preliminary results show the mother tincture of Calendula presents all the quality parameters required for use in homeopathic medicine. The formulations developed showed a pH drop in all gels as well as a viscosity decrease for gels stored in the greenhouse for 30 days. The gels stored at room temperature did not have alterations in their organoleptic characteristics. The gels were applied in 8 ICU patients and it was observed that the treatment with Calendula gel was more effective, as it inhibited microbial growth in 50% of the patients, after 3 sample collections. The study is underway with an expected duration of 6 months.
Keywords: Intensive care unit, ventilator-associated pneumonia, chlorhexidine, Calendula officinalis, homeopathy