Effectiveness of oral care with chlorhexidine in preventing ventilator-associated pneumonia: a Meta-analysis

Abstract

Objective We aimed to evaluate the correlation of oral care with chlorhexidine on the incidence of ventilator-associated pneumonia. Methods The PubMed, Medline, Cochrane Library, CNKI, VIP, Wanfang database until December 2013 about the clinical randomized controlled trials (RCT) of the oral care with chlorhexidine on the incidence of ventilator-associated pneumonia were searched. Software for data analysis was RevMan5.2. Results Finally 15 RCTs involving 2 615 patients were included. In 15 articles the experimental group used chlorhexidine solution or gel for oral nursing involving 1 319 cases, the control group with a total of 1 296 cases, used placebo for oral nursing involving 459 cases, 837 cas-es used 0.9% saline solution or sterile water. Results of Meta-analysis indicated that there were 11.30% (149/1 319) patients with VAP in the experimental group, 20.29% (263/1 296) patients in the control group. The VAP incidence between two groups had significantly statistical difference [OR=0.48, 95% confidence intervals (CI) was from 0.34 to 0.67, P 0.05]. The incidence of VAP in oral care with chlorhexidine solution group (tooth brushing) was 10.32%(42/407), in the control group the incidence of VAP was 14.16% (50/353), there was significantly statistical difference between two groups [OR=0.55, 95% CI 0.34 to 0.90, P<0.05]. Conclusions Oral care with chlorhexidine solution (tooth brush-ing or no tooth brushing) can effectively reduce the incidence of ventilator associated pneumonia. There was no sufficient evidence to indicate that using chlorhexidine gel (no tooth brushing) for oral care can reduce the incidence of ventilator associated pneumonia. Key words: Chlorhexidine; Oral care; Ventilator-associated pneumonia; Meta-analysis