They said that chlorhexidine gluconate effectively diminished the bacterial load of dental plaque, reducing its pathogenic potential, and oral decontamination effectively decreased the incidence of VAP in patients hospitalized in ICUs. These data are in agreement with the effects shown by others. Although not critically ill and not usually requiring mechanical ventilation support for > 24 h, patients undergoing elective cardiac surgery are likely to develop VAP. For example, their study found a decreased incidence of VAP with oral hygiene and chlorhexidine gluconate oral rinses 72h before surgery and therefore before endotracheal intubation. There are reports showing that oropharyngeal cleansing with 0.2% chlorhexidine solution was similar in antimicrobial properties to oral cleansing with potassium permanganate. Moreover, published results regarding the efficacy of a local antiseptic and oral hygiene in preventing VAP are controversial.