Impact of oral care with versus without toothbrushing on the prevention of ventilator-associated pneumonia: a systematic review and meta-analysis of randomized controlled trials

Abstract

IntroductionVentilator-associated pneumonia (VAP) remains a common hazardous complication in mechanically ventilated patients and is associated with increased morbidity and mortality. We undertook a systematic review and meta-analysis of randomized controlled trials to assess the effect of toothbrushing as a component of oral care on the prevention of VAP in adult critically ill patients.MethodsA systematic literature search of PubMed and Embase (up to April 2012) was conducted. Eligible studies were randomized controlled trials of mechanically ventilated adult patients receiving oral care with toothbrushing. Relative risks (RRs), weighted mean differences (WMDs), and 95% confidence intervals (CIs) were calculated and heterogeneity was assessed with the I2 test.ResultsFour studies with a total of 828 patients met the inclusion criteria. Toothbrushing did not significantly reduce the incidence of VAP (RR, 0.77; 95% CI, 0.50 to 1.21) and intensive care unit mortality (RR, 0.88; 95% CI, 0.70 to 1.10). Toothbrushing was not associated with a statistically significant reduction in duration of mechanical ventilation (WMD, -0.88 days; 95% CI, -2.58 to 0.82), length of intensive care unit stay (WMD, -1.48 days; 95% CI, -3.40 to 0.45), antibiotic-free day (WMD, -0.52 days; 95% CI, -2.82 to 1.79), or mechanical ventilation-free day (WMD, -0.43 days; 95% CI, -1.23 to 0.36).ConclusionsOral care with toothbrushing versus without toothbrushing does not significantly reduce the incidence of VAP and alter other important clinical outcomes in mechanically ventilated patients. However, the results should be interpreted cautiously since relevant evidence is still limited, although accumulating. Further large-scale, well-designed randomized controlled trials are urgently needed.

Efficacy of toothbrushing procedures performed in intensive care units in reducing the risk of ventilator‐associated pneumonia: A systematic review

“…Both previous SR evaluating the OHM with versus without toothbrushing on the prevention of VAP concluded that toothbrushing does not promote a significant reduction in VAP incidence in mechanically ventilated patients. The first included only four studies and the second six, while the present SR included 12.…”

“…Moreover, a recent ‘overview of SRs’ by Rabelo et al found that the use of CHX was effective in preventing VAP in cardiothoracic intensive care unit (ICU). Another couple of SRs of randomized clinical trials (RCT) evaluating toothbrushing on the prevention of VAP did not find differences between OHM with toothbrushing versus without toothbrushing . However, and regardless of their significant work these SRs were published >5 years ago, and since then the base of evidence has improved.…”

Effectiveness of a Dental Care Intervention in the Prevention of Lower Respiratory Tract Nosocomial Infections among Intensive Care Patients: A Randomized Clinical Trial

“…[22][23][24] In most ICUs worldwide, oral care is performed by nurse staff, but they do not have enough training or legal permission to treat caries, remove calculus, drain intraoral abscesses, or perform tooth extractions, as critical patients may need. [25][26][27] In Brazil, many of these procedures are frequently needed because of the poor oral health of the general population, with a mean decayed/missing/filled/teeth index of 27.53 in the age range of 65-74 years. 28 Our data support the hypothesis that a dental surgeon may make a difference in this scenario, thus enhancing the effect of oral antiseptics and preventing around 56.0% of LRTI episodes.…”

Prävention der nosokomialen beatmungsassoziierten Pneumonie

“…In 2 Metaanalysen von 4 bzw. 6 Studien konnte kein Vorteil der mechanischen Zahnreinigung gefunden werden, allerdings ist die Evidenz aufgrund der kleinen Patientenzahl und einer hohen Heterogenität der Studien noch gering [148,149].…”