Topical chlorhexidine for prevention of ventilator-associated pneumonia: a meta-analysis.

Abstract

OBJECTIVE:

To assess the efficacy of topical chlorhexidine for prevention of ventilator-associated pneumonia (VAP) in a meta-analysis.

DATA SOURCE:

Computerized PubMed and MEDLINE search supplemented by manual searches for relevant articles.

STUDY SELECTION:

Randomized controlled trials evaluating efficacy of topical chlorhexidine applied to the oropharynx vs. placebo or standard care for prevention of VAP.

DATA EXTRACTION:

Data were extracted on patient population, inclusion and exclusion criteria, diagnostic criteria for VAP, form and concentration of topical chlorhexidine used, incidence of VAP, and overall mortality.

DATA SYNTHESIS:

Data on incidence of VAP and mortality were abstracted as dichotomous variables. Pooled estimates of the relative risk and 95% confidence intervals were obtained using the DerSimonian and Laird random effects model and the Mantel-Haenszel fixed effects model. Heterogeneity was assessed using the Cochran Q statistic and I. Subgroup analyses were used to explore heterogeneity.

RESULTS:

Seven randomized controlled trials met the inclusion criteria. Topical chlorhexidine resulted in a reduced incidence of VAP (relative risk, 0.74; 95% confidence interval, 0.56-0.96; p=.02) using a fixed effects model. Using the more conservative random effects model, the point estimate was similar (relative risk, 0.70; 95% confidence interval, 0.47-1.04; p=.07), but the results failed to achieve statistical significance. The I test showed moderate heterogeneity. Subgroup analysis showed that the benefit of chlorhexidine was most marked in cardiac surgery patients (relative risk, 0.41; 95% confidence interval, 0.17-0.98; p=.04). There was no mortality benefit with chlorhexidine although the sample size was small.

CONCLUSIONS:

Our analysis showed that topical chlorhexidine is beneficial in preventing VAP; the benefit is most marked in cardiac surgery patients. A large randomized trial is needed to determine the impact of topical chlorhexidine on mortality.

• Authors: Maciej Piotr Chlebicki, Nasia Safdar
• Journal: Critical care medicine (Crit Care Med) Vol. 35 Issue 2 Pg. 595-602 (Feb 2007) ISSN: 0090-3493 [Print] United States
• PMID: 17205028 (Publication Type: Journal Article, Meta-Analysis, Research Support, Non-U.S. Gov't)

Chemical References

• Anti-Infective Agents, Local
• Chlorhexidine

Topics

• Administration, Topical
• Anti-Infective Agents, Local (administration & dosage)
• Chlorhexidine (administration & dosage)
• Humans
• Pneumonia, Ventilator-Associated (prevention & control)
• Randomized Controlled Trials as Topic