Preoperative chlorhexidine mouthwash to reduce pneumonia after cardiac surgery: A systematic review and meta-analysis

Abstract

Objective: Postoperative pneumonia is one of the most common complications after cardiac surgery, entailing increased patient morbidity, mortality, and health care burden. The primary aim of this study was to assess whether preoperative chlorhexidine mouthwash is associated with reduced postoperative pneumonia after cardiac surgery.Methods: A comprehensive systematic search of NLM Pubmed, Embase, Scopus, and Cumulative Index of Nursing and Allied Health was executed to include the studies since inception to June 27, 2017, which assessed the effects of preoperative chlorhexidine gluconate mouthwash on postoperative pneumonia. Studies were identified by 2 independent reviewers, and data were extracted using a predefined protocol. Random effects models were run to obtain risk ratios with 95% confidence intervals. Quality of evidence was evaluated using Grading of Recommendations Assessment, Development and Evaluation criteria. Postoperative pneumonia after cardiac surgery was the primary outcome of the study.Results: Five studies including a cumulative of 2284 patients were included. A total of 1125 patients received preoperative chlorhexidine. Use of chlorhexidine gluconate was associated with reduced risk of postoperative pneumonia compared with the patients who did not receive it (risk ratio, 0.52; 95% confidence interval, 0.39-0.70; P<.001). No adverse effects from chlorhexidine gluconate mouthwash were reported by any of these studies.Conclusions: Among the patients receiving preoperative chlorhexidine mouthwash, the risk of postoperative pneumonia is reduced by approximately onehalf; its adoption in preoperative protocols could help improve patient outcomes.

Pulmonary Complications of Cardiac Surgery

“…Diaphragmatic atrophy is also noted with prolonged paralysis, depicted as a diaphragmatic thickness below 0.2 cm at end expiration. Other ultrasound modalities used include diaphragmatic thickening and diaphragmatic excursion fraction to assess function [63]. Management of diaphragmatic dysfunction typically requires supportive care, while addressing potential differential causes.…”

Development and Validation of a Risk Prediction Model for Postoperative Pneumonia in Adult Patients Undergoing Stanford Type a Acute Aortic Dissection Surgery: A Case Control Study

“…Our prediction model may also play an important role in identifying and targeting high-risk patients for preventative measures. Several interventions have been shown to signi cantly reduce the incidence of POP, including subglottic secretion drainage [33], preoperative chlorhexidine mouthwash [34], and silvercoated endotracheal tubes [35]. Speci c interventions and appropriate preventative measures targeting high-risk patients identi ed by our prediction model may yield substantial clinical and economic bene ts.…”

Antiviral mouthwashes: possible benefit for COVID-19 with evidence-based approach

“…Results of a study of hospitalized patients have also shown that pathogenic microorganisms are present in patients’ mouths from day one and show an increasing trend during hospitalization [ 35 ]. Therefore, it seems that the use of CHX in COVID-19 patients who have altered oral flora, whether in a hospital or non-hospital setting is an important procedure to improve the symptoms in these patients [ 25 , 36 ].…”

“…A systematic review in 2016 of more than 38 RCTs found that increased oral hygiene by mouthwashes can prevent developing ventilator-associated pneumonia in critically ill patients [21]. Different studies have evaluated the antiviral effect of Povidone Iodine, 0.12%-chlorhexidine gluconate, Cetylpyridinium chloride, C31 G, chloroxylenol, benzalkonium chloride and cetrimide/Chlorhexidine [22][23][24][25][26][27].…”