[Oral hygiene with chlorhexidine on the prevention of ventilator-associated pneumonia in intubated patients: a systematic review of randomized clinical trials].
OBJECTIVE
Mechanical ventilation is used in about one third of patients in intensive cares units (ICU). Ventilator Associated-Pneumonia (VAP) is a frequent infectious complication, affecting approximately 8 to 28% patients. Strategies to prevent the development of VAP are key factors in the management of ICU patients. There have been proposed several strategies to prevent VAP. One of these is oral hygiene with clorhexidine. We evaluated the effect of chlorhexidine on the prevention of VAP.


METHODS
We conducted a systematic review of controlled clinical trials evaluating the effect of oral hygiene on VAP prevention. A PubMed search was performed using the following keywords: "oral care OR oral hygiene OR chlorhexidine AND ventilator-associated pneumonia". An independent reviewer evaluated the studies according to the inclusion criteria and extracted the data.


RESULTS
A total of 120 articles were found, and 10 of them met the inclusion criteria. A lack of uniformity was appreciated in the application of chlorhexidine. There was a reduction in the risk of VAP in the chlorhexidine group versus control (OR: 0,56, 95% CI: 0,44-0,73). However, neither a reduction in mortality, nor a length of MV nor an ICU length of stay were seen.


CONCLUSIONS
Oral hygiene with chlorhexidine in combination with other strategies for VAP prevention should be included in the patient's ICU care.
Carvajal
Carlos
C
Unidad de Cuidados Intensivos, Fundación Clínica Shaio, Bogotá, Colombia.
Pobo
Angel
A
Díaz
Emili
E
Lisboa
Thiago
T
Llauradó
Mireia
M
Rello
Jordi
J
D000891:Anti-Infective Agents, Local / Q000627:therapeutic use*; D002710:Chlorhexidine / Q000627:therapeutic use*; D006801:Humans; D007440:Intubation / Q000009:adverse effects; D009910:Oral Hygiene / Q000379:methods*; D053717:Pneumonia, Ventilator-Associated / Q000517:prevention & control*; D016032:Randomized Controlled Trials as Topic
D000891:Anti-Infective Agents, Local; D002710:Chlorhexidine