. Faculdade de Odontologia de Bauru, Universidade de São Paulo, Bauru (SP) Brasil.
Faculdade de Odontologia, UNISAGRADO, Bauru (SP) Brasil.
J Bras Pneumol. 2021 Jan 20;47(1):e20190286. doi: 10.36416/1806-3756/e20190286. eCollection 2021.
In ICU patients on mechanical ventilation (MV), ventilator-associated pneumonia (VAP) is a common infection. However, such infection can be prevented through oral care protocols. The objective of this study was to compare the efficiency of the use of chlorhexidine and oral hygiene protocols (brushing and clinical procedures) with that of the use of chlorhexidine alone (intervention group and control group, respectively) in decreasing the prevalence of VAP in patients ≥ 18 years of age admitted to the ICU and requiring MV.
In this systematic review and meta-analysis, studies were identified through searches of various national and international databases, as well as of the gray literature, and were selected in accordance with eligibility criteria.
We evaluated six studies, involving a collective total of 1,276 patients. We classified the risk of bias as low in three studies, high in two, and uncertain in one; among the six risk domains evaluated, a low risk of bias was predominant in five. The results for random risks were similar in terms of direction and statistical magnitude-chi-square = 6.34; risk difference: -0.06 (95% CI: -0.11 to -0.02); I2 = 21%; p = 0.007. There was a decrease in the prevalence of VAP in the intervention group (n = 1,276) included in the meta-analysis.
Protocols that include the mechanical removal of oral biofilm in combination with the use of chlorhexidine can reduce the incidence of VAP among ICU patients requiring MV.
在接受机械通气（MV）的 ICU 患者中，呼吸机相关性肺炎（VAP）是一种常见感染。然而，通过口腔护理方案可以预防此类感染。本研究的目的是比较使用洗必泰和口腔卫生方案（刷牙和临床操作）与单独使用洗必泰（干预组和对照组）对降低 ICU 中需要 MV 的≥18 岁患者 VAP 发生率的效果。
在本次系统评价和荟萃分析中，通过对各种国家和国际数据库以及灰色文献进行搜索，确定了研究，并根据纳入标准进行了选择。
我们评估了六项研究，共涉及 1276 名患者。我们将三项研究的偏倚风险归类为低，两项为高，一项为不确定；在所评估的六个风险领域中，有五个领域的偏倚风险较低。随机风险的结果在方向和统计幅度上相似-卡方=6.34；风险差异：-0.06（95%CI：-0.11 至-0.02）；I2=21%；p=0.007。在荟萃分析中，纳入的接受机械去除口腔生物膜并联合使用洗必泰的干预组的 VAP 发生率降低。
包括机械去除口腔生物膜并联合使用洗必泰的方案可以降低需要 MV 的 ICU 患者中 VAP 的发生率。
