Abstract
IntroductionVentilator-associated pneumonia (VAP) remains a common hazardous complication in mechanically ventilated patients and is associated with increased morbidity and mortality. We undertook a systematic review and meta-analysis of randomized controlled trials to assess the effect of toothbrushing as a component of oral care on the prevention of VAP in adult critically ill patients.MethodsA systematic literature search of PubMed and Embase (up to April 2012) was conducted. Eligible studies were randomized controlled trials of mechanically ventilated adult patients receiving oral care with toothbrushing. Relative risks (RRs), weighted mean differences (WMDs), and 95% confidence intervals (CIs) were calculated and heterogeneity was assessed with the I2 test.ResultsFour studies with a total of 828 patients met the inclusion criteria. Toothbrushing did not significantly reduce the incidence of VAP (RR, 0.77; 95% CI, 0.50 to 1.21) and intensive care unit mortality (RR, 0.88; 95% CI, 0.70 to 1.10). Toothbrushing was not associated with a statistically significant reduction in duration of mechanical ventilation (WMD, -0.88 days; 95% CI, -2.58 to 0.82), length of intensive care unit stay (WMD, -1.48 days; 95% CI, -3.40 to 0.45), antibiotic-free day (WMD, -0.52 days; 95% CI, -2.82 to 1.79), or mechanical ventilation-free day (WMD, -0.43 days; 95% CI, -1.23 to 0.36).ConclusionsOral care with toothbrushing versus without toothbrushing does not significantly reduce the incidence of VAP and alter other important clinical outcomes in mechanically ventilated patients. However, the results should be interpreted cautiously since relevant evidence is still limited, although accumulating. Further large-scale, well-designed randomized controlled trials are urgently needed.
Highlights
Ventilator-associated pneumonia (VAP) remains a common hazardous complication in mechanically ventilated patients and is associated with increased morbidity and mortality
Secondary outcomes Oral care with toothbrushing was not associated with decreases in intensive care unit (ICU) mortality (Figure 4), duration of mechanical ventilation (Figure 5), length of ICU stay (Figure 6), antibiotic-free day (Figure 7), and mechanical ventilation-free day (Figure 8)
Our meta-analysis suggests that oral care with toothbrushing did not significantly reduce the incidence of VAP in adult critically ill patients receiving mechanical ventilation
Summary
Ventilator-associated pneumonia (VAP) remains a common hazardous complication in mechanically ventilated patients and is associated with increased morbidity and mortality. We undertook a systematic review and meta-analysis of randomized controlled trials to assess the effect of toothbrushing as a component of oral care on the prevention of VAP in adult critically ill patients. There are published randomized controlled trials (RCTs) regarding the effect of oral care with toothbrushing on the prevention of VAP. These studies have a modest sample size and convey inconclusive results. We undertook a systematic review and metaanalysis of RCTs to assess the effects of oral care with toothbrushing on the incidence of VAP and other important clinical outcomes in adult critically ill patients receiving mechanical ventilation
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