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Vol. 46. Issue 5.
Pages 259-268 (May 2022)
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Vol. 46. Issue 5.
Pages 259-268 (May 2022)
Review
Should oral chlorhexidine remain in ventilator-associated pneumonia prevention bundles?
¿Debe permanecer la clorhexidina oral en los paquetes de prevención de la neumonía asociada al respirador?
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P.C. Vieiraa,b,c,
Corresponding author
paulacunhavieira@ufu.br

Corresponding author.
, R.B. de Oliveiraa, T.M. da Silva Mendonçab
a Intensive Care Unit, Uberlândia Clinical Hospital, Uberlândia Federal University, Uberlândia, Minas Gerais, Brazil
b Health Science PhD Program, Faculty of Medicine, Uberlândia Federal University, Uberlândia, Minas Gerais, Brazil
c Neurointensivism Postgraduate Program, Teaching and Research Institute, Sírio-Libanês Hospital, Bela Vista, São Paulo, Brazil
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Table 1. The PICO strategy of meta-analyses that assessed the association between the use of oral chlorhexidine for the prevention of ventilator-associated pneumonia and its impact on mortality.
Table 2. Summary of the results of metanalyses that assessed the association between oral chlorhexidine use for ventilator-associated pneumonia prevention and its impact on mortality.
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Abstract

Ventilator-associated pneumonia (VAP) is related with high mortality, duration of mechanical ventilation and costs. Recent studies have questioned the safety and effectiveness of oral chlorhexidine to prevent VAP. We sought to verify whether the adverse effects of this substance outweigh its benefits. We searched several databases and selected studies that investigated the use of oral chlorhexidine and its impact on mortality. No association between oral chlorhexidine and lower VAP rates was found on meta-analyses of double-blind randomized trials, however significant increase in mortality was reported. It is speculated that chlorhexidine can cause damage to several organic sectors and cytotoxicity. Although it still can be beneficial in specific settings, robust evidence to recommend its routine application for all mechanically ventilated patients is lacking; therefore, given the possibility of harm, it would be better to follow the principle of non-maleficence until more studies becomes available.

Keywords:
Chlorhexidine
Oral care
Mortality
Ventilator-associated pneumonia
Acute respiratory distress syndrome
Resumen

La neumonía asociada al respirador (VAP) está relacionada con una elevada mortalidad, mayor duración de la ventilación mecánica y costes elevados. Estudios recientes han cuestionado la seguridad y la eficacia de la clorhexidina oral para prevenir la VAP. Hemos intentado verificar si los efectos adversos de esta sustancia superan sus beneficios. Se realizaron búsquedas en diversas bases de datos y se seleccionaron estudios que habían investigado el uso de la clorhexidina oral y su impacto sobre la mortalidad. En los metaanálisis de los ensayos aleatorizados a doble ciego no se encontró ninguna asociación entre clorhexidina oral y tasas de VAP más bajas; sin embargo, sí se informó de un aumento significativo de la mortalidad. Se especula que la clorhexidina puede causar daño a varias partes del organismo y citotoxicidad. Pese a que todavía podría ser beneficiosa en entornos específicos, no se dispone de evidencias sólidas para recomendar su aplicación rutinaria para todos los pacientes sometidos a ventilación mecánica; por lo tanto, dada la posibilidad de ocasionar daños, sería mejor seguir el principio de no maleficencia hasta que se disponga de más estudios.

Palabras clave:
Clorhexidina
Cuidados orales
Mortalidad
Neumonía asociada al respirador
Síndrome de dificultad respiratoria aguda

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