Does chlorhexidine reduce the incidence of ventilator-associated pneumonia in ICU patients? A systematic review and meta-analysis
This study aimed to investigate chlorhexidine’s efficacy in preventing ventilator-associated pneumonia (VAP). A systematic review and meta-analysis were conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The data were obtained from Pubmed, Cochrane Library, a...
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| Veröffentlicht in: | Medicina intensiva 2023-08, Vol.47 (8), p.437-444 |
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| creator | Cruz, J.C. Martins, C.K. Piassi, J.E.V. Garcia Júnior, I.R. Santiago Junior, J.F. Faverani, L.P. |
| description | This study aimed to investigate chlorhexidine’s efficacy in preventing ventilator-associated pneumonia (VAP).
A systematic review and meta-analysis were conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
The data were obtained from Pubmed, Cochrane Library, and EMBASE.
Only mechanically ventilated patients for at least 48h were included.
Randomized clinical trials applying any dosage form of chlorhexidine were eligible.
The relative risk (RR) of the VAP incidence and all-cause mortality was assessed using the random-effects model. The mean difference in days of mechanical ventilation duration and intensive care unit (ICU) length of stay were also appraised.
Ten studies involving 1233 patients were included in the meta-analysis. The oral application of CHX reduced the incidence of VAP (RR, 0.73 [95% CI, 0.55, 0.97]) and did not show an increase in all-cause mortality (RR, 1.13 [95% CI, 0.96, 1.32]).
CHX proved effective to prevent VAP. However, a conclusion on mortality rates could not be drawn because the quality of the evidence was very low for this outcome.
Este estudio tuvo como objetivo investigar la eficacia de la clorhexidina en la prevención de la neumonía asociada al ventilador (NAV).
se realizó una revisión sistemática y un metanálisis siguiendo los elementos de informe (PRISMA) Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
Los datos se obtuvieron de Pubmed, Cochrane Library y EMBASE.
solo se incluyeron pacientes con ventilación mecánica durante al menos 48 horas.
Fueron elegibles los ensayos clínicos aleatorios que aplicaban cualquier forma de dosificación de clorhexidina.
Se evaluó el riesgo relativo (RR) de incidencia de NAVM y mortalidad por todas las causas mediante el modelo de efectos aleatorios. También se evaluó la diferencia media en los días de duración de la ventilación mecánica y la duración de la estancia en la unidad de cuidados intensivos (UCI).
Diez estudios con 1233 pacientes se incluyeron en el metanálisis. La aplicación oral de CHX redujo la incidencia de VAP (RR, 0,73 [IC 95%, 0,55, 0,97]) y no mostró un aumento en la mortalidad por todas las causas (RR, 1,13 [IC 95%, 0,96, 1,32].
CHX demostró ser eficaz para prevenir la VAP. Sin embargo, no se pudo establecer una conclusión sobre las tasas de mortalidad porque la calidad de la evidencia fue muy baja para este resultado. |
| doi_str_mv | 10.1016/j.medine.2022.11.002 |
| format | Article |
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A systematic review and meta-analysis were conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
The data were obtained from Pubmed, Cochrane Library, and EMBASE.
Only mechanically ventilated patients for at least 48h were included.
Randomized clinical trials applying any dosage form of chlorhexidine were eligible.
The relative risk (RR) of the VAP incidence and all-cause mortality was assessed using the random-effects model. The mean difference in days of mechanical ventilation duration and intensive care unit (ICU) length of stay were also appraised.
Ten studies involving 1233 patients were included in the meta-analysis. The oral application of CHX reduced the incidence of VAP (RR, 0.73 [95% CI, 0.55, 0.97]) and did not show an increase in all-cause mortality (RR, 1.13 [95% CI, 0.96, 1.32]).
CHX proved effective to prevent VAP. However, a conclusion on mortality rates could not be drawn because the quality of the evidence was very low for this outcome.
Este estudio tuvo como objetivo investigar la eficacia de la clorhexidina en la prevención de la neumonía asociada al ventilador (NAV).
se realizó una revisión sistemática y un metanálisis siguiendo los elementos de informe (PRISMA) Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
Los datos se obtuvieron de Pubmed, Cochrane Library y EMBASE.
solo se incluyeron pacientes con ventilación mecánica durante al menos 48 horas.
Fueron elegibles los ensayos clínicos aleatorios que aplicaban cualquier forma de dosificación de clorhexidina.
Se evaluó el riesgo relativo (RR) de incidencia de NAVM y mortalidad por todas las causas mediante el modelo de efectos aleatorios. También se evaluó la diferencia media en los días de duración de la ventilación mecánica y la duración de la estancia en la unidad de cuidados intensivos (UCI).
Diez estudios con 1233 pacientes se incluyeron en el metanálisis. La aplicación oral de CHX redujo la incidencia de VAP (RR, 0,73 [IC 95%, 0,55, 0,97]) y no mostró un aumento en la mortalidad por todas las causas (RR, 1,13 [IC 95%, 0,96, 1,32].
CHX demostró ser eficaz para prevenir la VAP. Sin embargo, no se pudo establecer una conclusión sobre las tasas de mortalidad porque la calidad de la evidencia fue muy baja para este resultado.</description><identifier>ISSN: 2173-5727</identifier><identifier>EISSN: 2173-5727</identifier><identifier>EISSN: 1578-6749</identifier><identifier>DOI: 10.1016/j.medine.2022.11.002</identifier><identifier>PMID: 36464582</identifier><language>eng</language><publisher>Spain: Elsevier España, S.L.U</publisher><subject>Agentes antimicrobianos ; Antimicrobial agents ; Chlorhexidine ; Chlorhexidine - therapeutic use ; Clorhexidina ; Humans ; Incidence ; Intensive Care Units ; Meta-analysis ; Metanálisis ; Neumonía asociada a ventilador ; Pneumonia, Ventilator-Associated - epidemiology ; Pneumonia, Ventilator-Associated - prevention & control ; Respiration, Artificial - adverse effects ; Ventilator-associated pneumonia</subject><ispartof>Medicina intensiva, 2023-08, Vol.47 (8), p.437-444</ispartof><rights>2022</rights><rights>Copyright © 2022. Published by Elsevier España, S.L.U.</rights><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c2072-9a71801f9ef60603277d9a3adf875c817d8ba7d16920d447b7be232341ae79883</citedby><cites>FETCH-LOGICAL-c2072-9a71801f9ef60603277d9a3adf875c817d8ba7d16920d447b7be232341ae79883</cites><orcidid>0000-0003-1735-2224 ; 0000-0002-2967-7723 ; 0000-0001-8892-781X ; 0000-0001-8301-005X ; 0000-0003-2249-3048 ; 0000-0002-9241-3456</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36464582$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Cruz, J.C.</creatorcontrib><creatorcontrib>Martins, C.K.</creatorcontrib><creatorcontrib>Piassi, J.E.V.</creatorcontrib><creatorcontrib>Garcia Júnior, I.R.</creatorcontrib><creatorcontrib>Santiago Junior, J.F.</creatorcontrib><creatorcontrib>Faverani, L.P.</creatorcontrib><title>Does chlorhexidine reduce the incidence of ventilator-associated pneumonia in ICU patients? A systematic review and meta-analysis</title><title>Medicina intensiva</title><addtitle>Med Intensiva (Engl Ed)</addtitle><description>This study aimed to investigate chlorhexidine’s efficacy in preventing ventilator-associated pneumonia (VAP).
A systematic review and meta-analysis were conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
The data were obtained from Pubmed, Cochrane Library, and EMBASE.
Only mechanically ventilated patients for at least 48h were included.
Randomized clinical trials applying any dosage form of chlorhexidine were eligible.
The relative risk (RR) of the VAP incidence and all-cause mortality was assessed using the random-effects model. The mean difference in days of mechanical ventilation duration and intensive care unit (ICU) length of stay were also appraised.
Ten studies involving 1233 patients were included in the meta-analysis. The oral application of CHX reduced the incidence of VAP (RR, 0.73 [95% CI, 0.55, 0.97]) and did not show an increase in all-cause mortality (RR, 1.13 [95% CI, 0.96, 1.32]).
CHX proved effective to prevent VAP. However, a conclusion on mortality rates could not be drawn because the quality of the evidence was very low for this outcome.
Este estudio tuvo como objetivo investigar la eficacia de la clorhexidina en la prevención de la neumonía asociada al ventilador (NAV).
se realizó una revisión sistemática y un metanálisis siguiendo los elementos de informe (PRISMA) Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
Los datos se obtuvieron de Pubmed, Cochrane Library y EMBASE.
solo se incluyeron pacientes con ventilación mecánica durante al menos 48 horas.
Fueron elegibles los ensayos clínicos aleatorios que aplicaban cualquier forma de dosificación de clorhexidina.
Se evaluó el riesgo relativo (RR) de incidencia de NAVM y mortalidad por todas las causas mediante el modelo de efectos aleatorios. También se evaluó la diferencia media en los días de duración de la ventilación mecánica y la duración de la estancia en la unidad de cuidados intensivos (UCI).
Diez estudios con 1233 pacientes se incluyeron en el metanálisis. La aplicación oral de CHX redujo la incidencia de VAP (RR, 0,73 [IC 95%, 0,55, 0,97]) y no mostró un aumento en la mortalidad por todas las causas (RR, 1,13 [IC 95%, 0,96, 1,32].
CHX demostró ser eficaz para prevenir la VAP. Sin embargo, no se pudo establecer una conclusión sobre las tasas de mortalidad porque la calidad de la evidencia fue muy baja para este resultado.</description><subject>Agentes antimicrobianos</subject><subject>Antimicrobial agents</subject><subject>Chlorhexidine</subject><subject>Chlorhexidine - therapeutic use</subject><subject>Clorhexidina</subject><subject>Humans</subject><subject>Incidence</subject><subject>Intensive Care Units</subject><subject>Meta-analysis</subject><subject>Metanálisis</subject><subject>Neumonía asociada a ventilador</subject><subject>Pneumonia, Ventilator-Associated - epidemiology</subject><subject>Pneumonia, Ventilator-Associated - prevention & control</subject><subject>Respiration, Artificial - adverse effects</subject><subject>Ventilator-associated pneumonia</subject><issn>2173-5727</issn><issn>2173-5727</issn><issn>1578-6749</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kEFPHCEUx0mjUWP9Bqbh2MtMgZkdmEsbs9XWxKQXPRMW3mTZzMDKY9Q99puXzWrjSS7w4Pf-L_wIueSs5ox33zb1BM4HqAUToua8Zkx8ImeCy6ZaSCGP3p1PyQXihpXVLbjizQk5bbq2axdKnJG_PyMgtesxpjW8-H0mTeBmCzSvgfpgvYNQqjjQJwjZjybHVBnEaL3J4Og2wDzF4E2B6e3ygW5N9oXEH_SK4g4zTOXCltQnD8_UBEcnyKYywYw79PiZHA9mRLh43c_Jw831_fJ3dffn1-3y6q6ygklR9UZyxfjQw9CxjjVCStebxrhByYVVXDq1MtLxrhfMta1cyRWIRjQtNyB7pZpz8vWQu03xcQbMevJoYRxNgDijFrKVjCnWdgVtD6hNETHBoLfJTybtNGd6719v9MG_3vvXnOviv7R9eZ0wr8rz_6Y32wX4fgCg_LPYSBqt39t1PoHN2kX_8YR_rtGZHQ</recordid><startdate>202308</startdate><enddate>202308</enddate><creator>Cruz, J.C.</creator><creator>Martins, C.K.</creator><creator>Piassi, J.E.V.</creator><creator>Garcia Júnior, I.R.</creator><creator>Santiago Junior, J.F.</creator><creator>Faverani, L.P.</creator><general>Elsevier España, S.L.U</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-1735-2224</orcidid><orcidid>https://orcid.org/0000-0002-2967-7723</orcidid><orcidid>https://orcid.org/0000-0001-8892-781X</orcidid><orcidid>https://orcid.org/0000-0001-8301-005X</orcidid><orcidid>https://orcid.org/0000-0003-2249-3048</orcidid><orcidid>https://orcid.org/0000-0002-9241-3456</orcidid></search><sort><creationdate>202308</creationdate><title>Does chlorhexidine reduce the incidence of ventilator-associated pneumonia in ICU patients? A systematic review and meta-analysis</title><author>Cruz, J.C. ; Martins, C.K. ; Piassi, J.E.V. ; Garcia Júnior, I.R. ; Santiago Junior, J.F. ; Faverani, L.P.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c2072-9a71801f9ef60603277d9a3adf875c817d8ba7d16920d447b7be232341ae79883</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Agentes antimicrobianos</topic><topic>Antimicrobial agents</topic><topic>Chlorhexidine</topic><topic>Chlorhexidine - therapeutic use</topic><topic>Clorhexidina</topic><topic>Humans</topic><topic>Incidence</topic><topic>Intensive Care Units</topic><topic>Meta-analysis</topic><topic>Metanálisis</topic><topic>Neumonía asociada a ventilador</topic><topic>Pneumonia, Ventilator-Associated - epidemiology</topic><topic>Pneumonia, Ventilator-Associated - prevention & control</topic><topic>Respiration, Artificial - adverse effects</topic><topic>Ventilator-associated pneumonia</topic><toplevel>online_resources</toplevel><creatorcontrib>Cruz, J.C.</creatorcontrib><creatorcontrib>Martins, C.K.</creatorcontrib><creatorcontrib>Piassi, J.E.V.</creatorcontrib><creatorcontrib>Garcia Júnior, I.R.</creatorcontrib><creatorcontrib>Santiago Junior, J.F.</creatorcontrib><creatorcontrib>Faverani, L.P.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Medicina intensiva</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Cruz, J.C.</au><au>Martins, C.K.</au><au>Piassi, J.E.V.</au><au>Garcia Júnior, I.R.</au><au>Santiago Junior, J.F.</au><au>Faverani, L.P.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Does chlorhexidine reduce the incidence of ventilator-associated pneumonia in ICU patients? A systematic review and meta-analysis</atitle><jtitle>Medicina intensiva</jtitle><addtitle>Med Intensiva (Engl Ed)</addtitle><date>2023-08</date><risdate>2023</risdate><volume>47</volume><issue>8</issue><spage>437</spage><epage>444</epage><pages>437-444</pages><issn>2173-5727</issn><eissn>2173-5727</eissn><eissn>1578-6749</eissn><abstract>This study aimed to investigate chlorhexidine’s efficacy in preventing ventilator-associated pneumonia (VAP).
A systematic review and meta-analysis were conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
The data were obtained from Pubmed, Cochrane Library, and EMBASE.
Only mechanically ventilated patients for at least 48h were included.
Randomized clinical trials applying any dosage form of chlorhexidine were eligible.
The relative risk (RR) of the VAP incidence and all-cause mortality was assessed using the random-effects model. The mean difference in days of mechanical ventilation duration and intensive care unit (ICU) length of stay were also appraised.
Ten studies involving 1233 patients were included in the meta-analysis. The oral application of CHX reduced the incidence of VAP (RR, 0.73 [95% CI, 0.55, 0.97]) and did not show an increase in all-cause mortality (RR, 1.13 [95% CI, 0.96, 1.32]).
CHX proved effective to prevent VAP. However, a conclusion on mortality rates could not be drawn because the quality of the evidence was very low for this outcome.
Este estudio tuvo como objetivo investigar la eficacia de la clorhexidina en la prevención de la neumonía asociada al ventilador (NAV).
se realizó una revisión sistemática y un metanálisis siguiendo los elementos de informe (PRISMA) Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
Los datos se obtuvieron de Pubmed, Cochrane Library y EMBASE.
solo se incluyeron pacientes con ventilación mecánica durante al menos 48 horas.
Fueron elegibles los ensayos clínicos aleatorios que aplicaban cualquier forma de dosificación de clorhexidina.
Se evaluó el riesgo relativo (RR) de incidencia de NAVM y mortalidad por todas las causas mediante el modelo de efectos aleatorios. También se evaluó la diferencia media en los días de duración de la ventilación mecánica y la duración de la estancia en la unidad de cuidados intensivos (UCI).
Diez estudios con 1233 pacientes se incluyeron en el metanálisis. La aplicación oral de CHX redujo la incidencia de VAP (RR, 0,73 [IC 95%, 0,55, 0,97]) y no mostró un aumento en la mortalidad por todas las causas (RR, 1,13 [IC 95%, 0,96, 1,32].
CHX demostró ser eficaz para prevenir la VAP. Sin embargo, no se pudo establecer una conclusión sobre las tasas de mortalidad porque la calidad de la evidencia fue muy baja para este resultado.</abstract><cop>Spain</cop><pub>Elsevier España, S.L.U</pub><pmid>36464582</pmid><doi>10.1016/j.medine.2022.11.002</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0003-1735-2224</orcidid><orcidid>https://orcid.org/0000-0002-2967-7723</orcidid><orcidid>https://orcid.org/0000-0001-8892-781X</orcidid><orcidid>https://orcid.org/0000-0001-8301-005X</orcidid><orcidid>https://orcid.org/0000-0003-2249-3048</orcidid><orcidid>https://orcid.org/0000-0002-9241-3456</orcidid></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 2173-5727 |
| ispartof | Medicina intensiva, 2023-08, Vol.47 (8), p.437-444 |
| issn | 2173-5727 2173-5727 1578-6749 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2747008046 |
| source | MEDLINE; Elsevier ScienceDirect Journals; Alma/SFX Local Collection |
| subjects | Agentes antimicrobianos Antimicrobial agents Chlorhexidine Chlorhexidine - therapeutic use Clorhexidina Humans Incidence Intensive Care Units Meta-analysis Metanálisis Neumonía asociada a ventilador Pneumonia, Ventilator-Associated - epidemiology Pneumonia, Ventilator-Associated - prevention & control Respiration, Artificial - adverse effects Ventilator-associated pneumonia |
| title | Does chlorhexidine reduce the incidence of ventilator-associated pneumonia in ICU patients? A systematic review and meta-analysis |
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