Abstract | OBJECTIVE: 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.
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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)
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Chemical References |
- Anti-Infective Agents, Local
- Chlorhexidine
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Topics |
- Administration, Topical
- Anti-Infective Agents, Local
(administration & dosage)
- Chlorhexidine
(administration & dosage)
- Humans
- Pneumonia, Ventilator-Associated
(prevention & control)
- Randomized Controlled Trials as Topic
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