title: Selective digestive or oropharyngeal decontamination and topical oropharyngeal chlorhexidine for prevention of death in general intensive care: systematic review and network meta-analysis.
abstract: OBJECTIVE
  To determine the effect on mortality of selective digestive decontamination, selective oropharyngeal decontamination, and topical oropharyngeal chlorhexidine in adult patients in general intensive care units and to compare these interventions with each other in a network meta-analysis.
  
  
  METHODS
  Systematic review, conventional meta-analysis, and network meta-analysis. Medline, Embase, and CENTRAL were searched to December 2012. Previous meta-analyses, conference abstracts, and key journals were also searched. We used pairwise meta-analyses to estimate direct evidence from intervention-control trials and a network meta-analysis within a Bayesian framework to combine direct and indirect evidence.
  
  
  METHODS
  Prospective randomised controlled trials that recruited adult patients in general intensive care units and studied selective digestive decontamination, selective oropharyngeal decontamination, or oropharyngeal chlorhexidine compared with standard care or placebo.
  
  
  RESULTS
  Selective digestive decontamination had a favourable effect on mortality, with a direct evidence odds ratio of 0.73 (95% confidence interval 0.64 to 0.84). The direct evidence odds ratio for selective oropharyngeal decontamination was 0.85 (0.74 to 0.97). Chlorhexidine was associated with increased mortality (odds ratio 1.25, 1.05 to 1.50). When each intervention was compared with the other, both selective digestive decontamination and selective oropharyngeal decontamination were superior to chlorhexidine. The difference between selective digestive decontamination and selective oropharyngeal decontamination was uncertain.
  
  
  CONCLUSIONS
  Selective digestive decontamination has a favourable effect on mortality in adult patients in general intensive care units. In these patients, the effect of selective oropharyngeal decontamination is less certain. Both selective digestive decontamination and selective oropharyngeal decontamination are superior to chlorhexidine, and there is a possibility that chlorhexidine is associated with increased mortality.
authors.affiliation: Intensive Care Unit, Royal Alexandra Hospital, Paisley PA2 9PN, UK.
authors.forename: Richard
authors.initials: R
authors.lastname: Price
authors.forename: Graeme
authors.initials: G
authors.lastname: MacLennan
authors.forename: John
authors.initials: J
authors.lastname: Glen
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002710:Chlorhexidine / Q000008:administration & dosage / Q000627:therapeutic use*; D003422:Critical Care / Q000379:methods*; D003666:Decontamination / Q000379:methods*; D004202:Disinfectants / Q000008:administration & dosage / Q000627:therapeutic use*; D041981:Gastrointestinal Tract / Q000382:microbiology*; D017052:Hospital Mortality; D006801:Humans; D009960:Oropharynx / Q000382:microbiology*
chemical_list: D000900:Anti-Bacterial Agents; D004202:Disinfectants; D002710:Chlorhexidine