Pineda Lilibeth A, Saliba Ranime G, El Solh Ali A
Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, NY, USA.
Crit Care. 2006 Feb;10(1):R35. doi: 10.1186/cc4837.
Nosocomial pneumonia is a significant cause of in-hospital morbidity and mortality. Oral care interventions have great potential to reduce the occurrence of nosocomial pneumonia. Studies using topical antiseptic agents yielded mixed results. We hypothesized that the use of chlorhexidine for oral decontamination would reduce the incidence of nosocomial pneumonia in patients requiring mechanical ventilation.
This study is a meta-analysis of randomized controlled trials assessing the effect of chlorhexidine on the incidence of nosocomial pneumonia. Data sources were Medline, EMBASE, Cochrane library, citation review of relevant primary and review articles, and contact with expert informants. Out of 1,251 articles screened, 4 randomized, controlled trials were identified that included a total of 1,202 patients. Descriptive and outcome data were extracted by two reviewers independently. Main outcome measures were the incidence of nosocomial pneumonia, and mortality. A random effects model was used.
The incidence of nosocomial pneumonia in the control group was 7% (41 out of 615) compared to 4% (24 out of 587) in the treatment group. Gram-negative bacteria accounted for 78% of the total isolates, with Pseudomonas aeruginosa being the most frequently isolated pathogen irrespective of the intervention provided. Duration of mechanical ventilation and intensive care unit length of stay were comparable between the two groups. Overall, the use of oral decontamination with chlorhexidine did not affect the incidence of nosocomial pneumonia (odds ratio of 0.42; 95% confidence interval 0.16-1.06) or the mortality rate (odds ratio 0.77, 95% confidence interval 0.28-2.11).
The use of oral decontamination with chlorhexidine did not result in significant reduction in the incidence of nosocomial pneumonia in patients who received mechanical ventilation, nor altered the mortality rate. The lack of benefit may reflect the few studies conducted in this area. Future trials should focus on a combination strategy of mechanical and pharmacological interventions.
医院获得性肺炎是住院患者发病和死亡的重要原因。口腔护理干预措施在降低医院获得性肺炎的发生率方面具有巨大潜力。使用局部抗菌剂的研究结果不一。我们假设，使用洗必泰进行口腔去污可降低需要机械通气患者的医院获得性肺炎发生率。
本研究是一项对评估洗必泰对医院获得性肺炎发生率影响的随机对照试验的荟萃分析。数据来源为医学期刊数据库（Medline）、荷兰医学文摘数据库（EMBASE）、考科蓝图书馆、对相关原始文献和综述文章的引文回顾以及与专家信息提供者的联系。在筛选的1251篇文章中，确定了4项随机对照试验，共纳入1202例患者。描述性数据和结果数据由两名研究者独立提取。主要结局指标为医院获得性肺炎的发生率和死亡率。采用随机效应模型。
对照组医院获得性肺炎的发生率为7%（615例中有41例），而治疗组为4%（587例中有24例）。革兰氏阴性菌占分离菌株总数的78%，无论采取何种干预措施，铜绿假单胞菌都是最常分离出的病原体。两组之间机械通气时间和重症监护病房住院时间相当。总体而言，使用洗必泰进行口腔去污并未影响医院获得性肺炎的发生率（优势比为0.42；95%置信区间为0.16 - 1.06）或死亡率（优势比为0.77，95%置信区间为0.28 - 2.11）。
对接受机械通气的患者使用洗必泰进行口腔去污，并未显著降低医院获得性肺炎的发生率，也未改变死亡率。缺乏益处可能反映了该领域开展的研究较少。未来的试验应侧重于机械和药物干预的联合策略。
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