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Original article
Available online 2 December 2022
Does chlorhexidine reduce the incidence of ventilator-associated pneumonia in ICU patients? A systematic review and meta-analysis
¿El cuidado bucal de rutina con clorhexidina reduce la incidencia de neumonía asociada al ventilador en pacientes de la UCI? Una revisión sistemática y metanálisis
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J.C. Cruza,
Corresponding author
jonas-cruz@hotmail.com

Corresponding author.
, C.K. Martinsb, J.E.V. Piassic, I.R. Garcia Júniorc, J.F. Santiago Juniord, L.P. Faveranic
a University of São Paulo (USP), Ribeirão Preto, Brazil
b Department of Medicine, University of Ribeirão Preto (UNAERP), Ribeirão Preto, Brazil
c Division of Oral and Maxillofacial Surgery, Department of Diagnosis and Surgery, São Paulo State University (UNESP), School of Dentistry, Araçatuba, São Paulo, Brazil
d Department of Health Sciences. Dentistry Course, Unisagrado: Centro Universitário Sagrado Coração, Bauru, SP, Brazil
Received 06 July 2022. Accepted 20 October 2022
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Abstract
Objective

This study aimed to investigate chlorhexidine’s efficacy in preventing ventilator-associated pneumonia (VAP).

Design

A systematic review and meta-analysis were conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

Settings

The data were obtained from Pubmed, Cochrane Library, and EMBASE.

Patients or participants

Only mechanically ventilated patients for at least 48h were included.

Interventions

Randomized clinical trials applying any dosage form of chlorhexidine were eligible.

Main variables of interest

The relative risk (RR) of the VAP incidence and all-cause mortality was assessed using the random-effects model. The mean difference in days of mechanical ventilation duration and intensive care unit (ICU) length of stay were also appraised.

Results

Ten studies involving 1233 patients were included in the meta-analysis. The oral application of CHX reduced the incidence of VAP (RR, 0.73 [95% CI, 0.55, 0.97]) and did not show an increase in all-cause mortality (RR, 1.13 [95% CI, 0.96, 1.32]).

Conclusions

CHX proved effective to prevent VAP. However, a conclusion on mortality rates could not be drawn because the quality of the evidence was very low for this outcome.

Keywords:
Antimicrobial agents
Meta-analysis
Chlorhexidine
Ventilator-associated pneumonia
Resumen
Objetivo

Este estudio tuvo como objetivo investigar la eficacia de la clorhexidina en la prevención de la neumonía asociada al ventilador (NAV).

Diseño

se realizó una revisión sistemática y un metanálisis siguiendo los elementos de informe (PRISMA) Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

Ámbito

Los datos se obtuvieron de Pubmed, Cochrane Library y EMBASE.

Pacientes o participantes

solo se incluyeron pacientes con ventilación mecánica durante al menos 48 horas.

Intervenciones

Fueron elegibles los ensayos clínicos aleatorios que aplicaban cualquier forma de dosificación de clorhexidina.

Variables de interés principales

Se evaluó el riesgo relativo (RR) de incidencia de NAVM y mortalidad por todas las causas mediante el modelo de efectos aleatorios. También se evaluó la diferencia media en los días de duración de la ventilación mecánica y la duración de la estancia en la unidad de cuidados intensivos (UCI).

Resultados

Diez estudios con 1233 pacientes se incluyeron en el metanálisis. La aplicación oral de CHX redujo la incidencia de VAP (RR, 0,73 [IC 95%, 0,55, 0,97]) y no mostró un aumento en la mortalidad por todas las causas (RR, 1,13 [IC 95%, 0,96, 1,32].

Conclusiones

CHX demostró ser eficaz para prevenir la VAP. Sin embargo, no se pudo establecer una conclusión sobre las tasas de mortalidad porque la calidad de la evidencia fue muy baja para este resultado.

Palabras clave:
Agentes antimicrobianos
Metanálisis
Clorhexidina
Neumonía asociada a ventilador

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