The effectiveness of different concentrations of chlorhexidine for prevention of ventilator‐associated pneumonia: a meta‐analysis

Zhang, Tingting; Tang, Shanshan; Fu, Lijuan

doi:10.1111/jocn.12312

Cited by 45 publications

(44 citation statements)

References 33 publications

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“…Evidence supporting the inclusion of CHX in the daily oral care of patients who are mechanically ventilated to reduce the risk of VAP was reported in our initial investigations 3 and was confi rmed by others in subsequent clinical trials and meta-analyses. 4,5 We also found that early application of a single dose of CHX (immediately aft er intubation) reduced earlyonset VAP. 6 A Cochrane review concluded that chlorhexidine, either as a mouthwash or as a gel, is associated with a 40% reduction in the odds of developing VAP in critically ill adults.…”

mentioning

confidence: 65%

Preintubation Application of Oral Chlorhexidine Does Not Provide Additional Benefit in Prevention of Early-Onset Ventilator-Associated Pneumonia

Munro

Grap

Sessler

et al. 2015

Chest

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BACKGROUND: Daily application of oral chlorhexidine gluconate (CHX) following intubation to reduce the risk of ventilator-associated pneumonia (VAP) is now the standard of care in many ICUs. Th is randomized clinical trial evaluated the benefi t of adding a preintubation CHX dose to the known benefi t of postintubation CHX to reduce the risk of early-onset VAP. A secondary aim was to test the effect of a preintubation oral application of CHX on early endotracheal tube (ETT) colonization.

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mentioning

confidence: 65%

Preintubation Application of Oral Chlorhexidine Does Not Provide Additional Benefit in Prevention of Early-Onset Ventilator-Associated Pneumonia

Munro

Grap

Sessler

et al. 2015

Chest

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“…Among these antiseptics, chlorhexidine gluconate has attracted considerable attention, as evidenced by numerous randomized controlled clinical trials that have investigated the effect of oral chlorhexidine use in VAP prevention. [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] Results from the aforementioned randomized controlled trials and meta-analyses [26][27][28][29][30] that analyzed the effect of oral care with chlorhexidine on VAP prevention are conflicting. Discrepant findings may have resulted from differences in study populations, diagnostic criteria for VAP, chlorhexidine concentration, and frequency of use.…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of Intraoral Chlorhexidine Protocols in the Prevention of Ventilator-Associated Pneumonia: Meta-Analysis and Systematic Review

et al. 2016

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BACKGROUND: Ventilator-associated pneumonia (VAP) is common in critical patients and related with increased morbidity and mortality. We conducted a systematic review and meta-analysis, with intention-to-treat analysis, of randomized controlled clinical trials that assessed the effectiveness of different intraoral chlorhexidine protocols for the prevention of VAP. METHODS: Search strategies were developed for the MEDLINE, EMBASE, and LILACS databases. MeSH terms were combined with Boolean operators and used to search the databases. Eligible studies were randomized controlled trials of mechanically ventilated subjects receiving oral care with chlorhexidine or standard oral care protocols consisting of or associated with the use of a placebo or no chemicals. Pooled estimates of the relative risk and corresponding 95% CIs were calculated with random effects models, and heterogeneity was assessed with the Cochran Q statistic and I 2 . RESULTS: The 13 included studies provided data on 1,640 subjects that were randomly allocated to chlorhexidine (n ‫؍‬ 834) or control (n ‫؍‬ 806) treatments. A preliminary analysis revealed that oral application of chlorhexidine fails to promote a significant reduction in VAP incidence (relative risk 0.80, 95% CI 0.59 -1.07, I2 ‫؍‬ 45%). However, subgroup analyses showed that chlorhexidine prevents VAP development when used at 2% concentration (relative risk 0.53, 95% CI 0.31-0.91, I 2 ‫؍‬ 0%) or 4 times/d (relative risk 0.56, 95% CI 0.38 -0.81, I2 ‫؍‬ 0%). CONCLUSIONS: We found that oral care with chlorhexidine is effective in reducing VAP incidence in the adult population if administered at 2% concentration or 4 times/d.

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“…However, as mechanically ventilated patients cannot be fed orally, their salivary secretions decrease, and there is a marked reduction in self-cleansing of the oral cavity. Additionally, an endotracheal tube can hamper the oral cavity and limit access for oral care, causing a pH imbalance in the oral cavity, decreasing saliva production, and making it easier for bacteria to colonize [6]. …”

Section: Introductionmentioning

confidence: 99%

Comparison of the effect of oral care with four different antiseptics to prevent ventilator-associated pneumonia in adults: protocol for a network meta-analysis

et al. 2017

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BackgroundVentilator-associated pneumonia (VAP) is defined as the occurrence of pneumonia in patients receiving mechanical ventilation for more than 48 h after endotracheal intubation. The implementation of effective oral care with antiseptics may reduce the incidence of ventilator-associated pneumonia. However, previous studies have been unclear about the best antiseptic for this purpose. Therefore, present protocol proposed to perform a network meta-analysis to evaluate the efficacy of different antiseptics to prevent ventilator-associated pneumonia.Methods/designWe will search CNKI, WanFang database, PubMed, Web of Science, Cochrane Library, EMBASE, SinoMed from their inception to March 2016. There are no restrictions on language, publication year, or publication type. Only randomized clinical trials (RCTs) with antiseptics to prevent ventilator-associated pneumonia will be considered. Study selection and data collection will be independently performed by two reviewers. Risk of bias assessments will be completed using the Cochrane risk of bias scale. The primary outcome is VAP morbidity. A network meta-analysis will be conducted to compare the effect of four different antiseptics on patient-relevant efficacy. Subgroup analyses will be performed by the type of setting and length of mechanical ventilation, and sensitivity analyses will be conducted to assess the robustness of the findings.DiscussionOral care to prevent ventilator-associated pneumonia has been widely used. The efficacy of usual oral antiseptics have been assessed mainly using traditional meta-analysis. However, it was unclear which oral care solution is best used for oral care and there were no head-to-head RCT to compare the efficacy of four antiseptics. The proposed network meta-analysis will compare four antiseptics and rank the results using network meta-analysis to decide which was the best.Systematic review registrationPROSPERO CRD42016038088 Electronic supplementary materialThe online version of this article (doi:10.1186/s13643-017-0496-5) contains supplementary material, which is available to authorized users.

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The effectiveness of different concentrations of chlorhexidine for prevention of ventilator‐associated pneumonia: a meta‐analysis

Abstract: Ventilator-associated pneumonia remains a leading cause of morbidity and mortality in intensive care unit, and implementing effective oral care can reduce the incidence of ventilator-associated pneumonia. Chlorhexidine of 0·12% is recommended in our study.

Cited by 45 publications

References 33 publications

Preintubation Application of Oral Chlorhexidine Does Not Provide Additional Benefit in Prevention of Early-Onset Ventilator-Associated Pneumonia

Preintubation Application of Oral Chlorhexidine Does Not Provide Additional Benefit in Prevention of Early-Onset Ventilator-Associated Pneumonia

Effectiveness of Intraoral Chlorhexidine Protocols in the Prevention of Ventilator-Associated Pneumonia: Meta-Analysis and Systematic Review

Comparison of the effect of oral care with four different antiseptics to prevent ventilator-associated pneumonia in adults: protocol for a network meta-analysis

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