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. 2015 Feb 15;8(2):1645-57.
eCollection 2015.

Can routine oral care with antiseptics prevent ventilator-associated pneumonia in patients receiving mechanical ventilation? An update meta-analysis from 17 randomized controlled trials

Longti Li  1 , Zhibing Ai  2 , Longzhu Li  3 , Xuesong Zheng  4 , Luo Jie  5
Affiliations

Can routine oral care with antiseptics prevent ventilator-associated pneumonia in patients receiving mechanical ventilation? An update meta-analysis from 17 randomized controlled trials

Longti Li et al. Int J Clin Exp Med. .

Abstract

Background: Whether oral antiseptics could reduce the risk of ventilator associated pneumonia (VAP) in patients receiving mechanical ventilation remains controversial. We performed a meta-analysis to assess the effect of oral care with antiseptics on the prevalence of ventilator associated pneumonia in adult critically ill patients.

Methods: A comprehensive search of PubMed, Embase and Web of Science were performed to identity relevant studies. Eligible studies were randomized controlled trials of mechanically ventilated adult patients receiving oral care with antiseptics. The quality of included studies was assessed by the Jadad score. Relative risks (RRs), weighted mean differences (WMDs), and 95% confidence intervals (CIs) were calculated and pooled using a fixed-effects model or random-effects model. Heterogeneity among the studies was assessed with I (2) test.

Results: 17 studies with a total number of 4249 met the inclusion criteria. Of the 17 studies, 14 assessed the effect of chlorhexidine, and 3 investigated the effect of povidone-iodine. Overall, oral care with antiseptics significantly reduced the prevalence of VAP (RR=0.72, 95% CI: 0.57, 0.92; P=0.008). The use of chlorhexidine was shown to be effective (RR=0.73, 95% CI: 0.57, 0.93; P=0.012), whereas this effect was not observed in povidone-iodine (RR=0.51, 95% CI: 0.09, 2.82; P=0.438). Subgroup analyses showed that oral antiseptics were most marked in cardiac surgery patients (RR=0.54, 95% CI: 0.39, 0.74; P=0.00). Patients with oral antiseptics did not have a reduction in intensive care unit (ICU) mortality (RR=1.11, 95% CI: 0.95, 1.29; P=0.201), length of ICU stay (WMD=-0.10 days, 95% CI: -0.25, 0.05; P=0.188), or duration of mechanical ventilation (WMD=-0.05 days, 95% CI: -0.14, 0.04; P=0.260).

Conclusion: Oral care with antiseptics significantly reduced the prevalence of VAP. Chlorhexidine application prevented the occurrence of VAP in mechanically ventilated patients but povidone-iodine did not. Further large-scale, well-designed randomized controlled trials are needed to identify the findings and determine the effect of povidone-iodine application.

Keywords: Oral care; antiseptics; meta-analysis; ventilator associated pneumonia.

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Figures

Figure 1
Figure 1
Search strategy and flow diagram for this meta-analysis.
Figure 2
Figure 2
Forest plot showing the effect of oral care with chlorhexidine or povidone-iodine on the prevalence of ventilator associated pneumonia (VAP).
Figure 3
Figure 3
Forest plot assessing publication bias for ventilator associated pneumonia.
Figure 4
Figure 4
Forest plot showing the effect of oral care with antiseptics on the prevalence of VAP in different surgery patients.
Figure 5
Figure 5
Forest plot showing the effect of oral care with chlorhexidine or povidone-iodine on intensive care unit (ICU) mortality.
Figure 6
Figure 6
Forest plot showing the effect of oral care with antiseptics on intensive care unit (ICU) mortality in different surgery patients.
Figure 7
Figure 7
Forest plot showing the effect of oral care with chlorhexidine or povidone-iodine on length of intensive unit stay (ICU).
Figure 8
Figure 8
Forest plot showing the effect of oral care with antiseptics on duration of mechanical ventilation.
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