Effectiveness of oral care in the prevention of ventilator-associated pneumonia. systematic review and meta-analysis of randomised clinical trials

Objective: To determine the effectiveness of oral care in preventing pneumonia associated with mechanical ventilation (VAP). Method: A search was made for randomised clinical trials (RCTs) in CINAHL, Cuiden Plus, Pub Med, EMBASE, ENFISPO, Cochrane, Cuiden, DARE, EBE, JBI, and reverse lookup from the beginning of indexing of each database up to 3 May 2010. There were no restrictions on language, age, sex or underlying disease. RCTs that compared oral care and determined their effectiveness in preventing VAP were included. The different interventions were analysed to determine the most effective and protective. Epidat 3.1 was used for analysing the data. Out of a total of 858 articles reviewed, only 14 met the inclusion criteria. Results: Using a random effects model statistically significant results were found in favour of chlorhexidine as a protective factor against VAP (RR = 0.7065, 95% CI: 0.5568-0.8963). The application of 0.12% chlorhexidine twice a day gave an RR: 0.69, 95% CI: 0.53 - 0.91 and 0.2% chlorhexidine four times daily: (RR = 0.53, 95% CI: 0.31 to 0.90), being statistically significant. The application of 0.12% and 0.2% chlorhexidine three times a day and brushing did not give statistically significant results. Conclusions: The use of chlorhexidine in oral care is a protective factor against VAP. Tooth brushing did not prevent VAP. More RCTs using this intervention are needed to confirm these results. (C) 2010 Elsevier Espana, S.L. All rights reserved.