Bellíssimo-Rodrigues et al.99 Bellissimo-Rodrigues WT, Menegueti MG, Gaspar GG, Nicolini EA, Auxiliadora-Martins M, Basile-Filho A, et al. Effectiveness of a dental care intervention in the prevention of lower respiratory tract nosocomial infections among intensive care patients: a randomized clinical trial. Infect Control Hosp Epidemiol. 2014;35(11):1342-1348. https://doi.org/10.1086/678427 https://doi.org/10.1086/678427...
/Brazil |
254 |
Tooth brushing, tongue scraping, calculus removal, atraumatic restorative treatment, tooth extraction, and irrigation with chlorhexidine at 0.12% or 2.0%, depending on the level of patient consciousness, 3 times a day (n = 127) |
Cleaning with gauze wrapped onto a tongue depressor, followed by rinsing with chlorhexidine at 0.12% or 2.0%, 3 times a day (n = 127) |
Prevalence of VAP Absolute frequency: IG: 18/127; CG: 8/127 Relative frequency: IG: 8.%; CG 18.% (RR = 0.38; 95% CI: 0.16-0.93; p = 0.030) |
Length of ICU stay, days: IG: 10.7 ± 10.6; CG: 11.3 ± 9.0 (p = 0.225) Mortality associated with lower respiratory tract infection: IG: 5/127; CG 8/127 (RR = 0.61; 95% CI: 0.19-1.92; p = 0.393) |
The IG had more favorable results in reducing VAP than did the CG (p < 0.05). There were no significant differences between the groups in terms of the length of ICU stay on MV and in-hospital mortality. |
Félix et al.1010 Félix LC. Two methods of oral hygiene with chlorhexidine in preventing of ventilator-associated pneumonia [dissertation]. Fortaleza: Faculdade de Farmácia, Odontologia e Enfermagem, Universidade Federal do Ceará; 2016./Brazil |
58 |
Tooth brushing with a toothbrush soaked in 0.12% chlorhexidine, 3 times a day (n = 30) |
Cleaning with gauze soaked in 0.12% chlorhexidine, 3 times a day (n = 28) |
Prevalence of VAP Absolute frequency: IG: 1/30; CG: 3/28 Relative frequency: IG: 3.3%; CG: 10.7% (p = 0.344) |
NR |
Neither protocol resulted in a significant decrease in the prevalence of VAP |
de Lacerda Vidal et al.1111 de Lacerda Vidal CF, Vidal AK, Monteiro JG Jr, Cavalcanti A, Henriques APC, Oliveira M, et al. Impact of oral hygiene involving toothbrushing versus chlorhexidine in the prevention of ventilator-associated pneumonia: a randomized study [published correction appears in BMC Infect Dis. 2017 Feb 27;17 (1):173]. BMC Infect Dis. 2017;17(1):112. https://doi.org/10.1186/s12879-017-2188-0 https://doi.org/10.1186/s12879-017-2188-...
/Brazil |
213 |
Tooth brushing with chlorhexidine gel at 0.12%, 2 times a day (n = 105) |
Irrigation with and suction extraction of chlorhexidine at 0.12%, 2 times a day (n = 108) |
Prevalence of VAP Absolute frequency: IG: 88/105; CG: 80/108 Relative frequency: IG: 37.8%; CG: 62.2% (RR = 1.81; 95% CI: 0.93-3.57; p = 0.084) |
Length of ICU stay, days IG = 8.7± 9.0; CG = 11.1 ± 7.6 (p = 0.018) In-hospital mortality: IG: 20/105 (42.5%); CG: 27/108 (57.5%) (RR = 1.41; 95% CI: 0.73-2.70; p = 0.2) |
The IG showed a significant reduction in the length of ICU stay on MV (p < 0.05), although there were no statistical differences between the groups in terms of the decrease of VAP prevalence or in-hospital mortality |
Lorente et al.1212 Lorente L, Lecuona M, Jiménez A, Palmero S, Pastor E, Lafuente N, et al. Ventilator-associated pneumonia with or without toothbrushing: a randomized controlled trial. Eur J Clin Microbiol Infect Dis. 2012;31(10):2621-2629. https://doi.org/10.1007/s10096-012-1605-y https://doi.org/10.1007/s10096-012-1605-...
/Spain |
436 |
Brushing teeth and tongue for 90 s + gauze soaked in 20 mL of 0.12% chlorhexidine + irrigation of 10 mL of 0.12% chlorhexidine in the oral cavity for 30 s, 3 times a day (n = 217) |
Cleaning with gauze soaked in 20 mL of 0.12% chlorhexidine + irrigation of 10 mL of 0.12% chlorhexidine in the oral cavity for 30 s, 3 times a day (n = 219) |
Prevalence of VAP Absolute frequency: IG: 21/217; CG: 24/219 Relative frequency: IG: 9.7%; CG: 11.0% (p = 0.75) |
Length of ICU stay, days: IG: 12.07 ± 15.55; CG: 13.04 ± 17.27 (p = 0.54) In-hospital mortality: IG: 62/217 (28.6%); CG: 69/219 (31.5%) (p = 0.53) |
There were no significant differences between the IG and CG in terms of the decrease in VAP prevalence, length of ICU stay, or in-hospital mortality. |
Nasiriani et al.1313 Nasiriani K, Torki F, Jarahzadeh MH, Rashidi Maybodi F. The Effect of Brushing with a Soft Toothbrush and Distilled Water on the Incidence of Ventilator-Associated Pneumonia in the Intensive Care Unit. Tanaffos. 2016;15(2):101-107./Iran |
168 |
Tooth brushing with a soft toothbrush with distilled water plus application of a cotton swab saturated in 0.12% chlorhexidine on the tongue, 2 times a day (n = 84) |
Use of saline solution and application of chlorhexidine on the tongue with a cotton swab soaked in the solution, 2 times a day (n = 84) |
Prevalence of VAP Absolute frequency: IG: 25/84; CG: 40/84 Relative frequency: IG: 29.8%; CG: 47.6% (p = 0.02) |
NR |
The prevalence of VAP in intubated ICU patients was lower in the IG (p < 0.05). |
Pobo et al.1414 Pobo A, Lisboa T, Rodriguez A, Sole R, Magret M, Trefler S, et al. A randomized trial of dental brushing for preventing ventilator-associated pneumonia. Chest. 2009;136(2):433-439. https://doi.org/10.1378/chest.09-0706 https://doi.org/10.1378/chest.09-0706...
/USA |
147 |
Electric toothbrush + use of 0.12% chlorhexidine, 3 times a day (n = 74) |
Use of 0.12% chlorhexidine, 3 times a day (n = 73) |
Prevalence of VAP Absolute frequency: IG: 15/74; CG: 18/73 Relative frequency: IG: 20.3%; CG: 24.7% (OR: 0.78; 95% CI: 0.36-1.65; p = 0.56) |
Length of ICU stay, days: IG: 8.9 ± 5.8; CG: 9.8 ± 6.1 (p = 0.45) In-hospital mortality General: 39/147 (26.5%) IG: 21.6%; CG: 31.5% (p = 0.19) |
There were no significant differences between the IG and CG in terms of the decrease in VAP prevalence, length of ICU stay, or in-hospital mortality. |