Yamakita Sachika, Unoki Takeshi, Niiyama Sachi, Natsuhori Eri, Haruna Junpei, Kuribara Tomoki
Department of Acute and Critical Care Nursing, Graduate School of Nursing, Master's Program, Sapporo City University, Sapporo, Hokkaido, Japan.
Department of Acute and Critical Care Nursing, School of Nursing, Sapporo City University, Sapporo, Hokkaido, Japan.
PLoS One. 2024 Dec 13;19(12):e0313057. doi: 10.1371/journal.pone.0313057. eCollection 2024.
Oral hygiene care is important for ventilator-associated pneumonia prevention. However, the optimal oral hygiene care approach remains unclear. A network meta-analysis was conducted to compare the efficacy of various oral hygiene care methods for ventilator-associated pneumonia prevention in critically ill patients, and the methods were ranked. A literature search of three representative databases was conducted. We only analyzed parallel randomized controlled trials conducted to analyze the use antiseptics or toothbrushes in oral hygiene care for adult patients undergoing invasive mechanical ventilation in the intensive care unit. The outcome measure was the incidence of ventilator-associated pneumonia. Bias risk was assessed using the Cochrane Risk of Bias 2 tool, and the confidence in the evidence was evaluated using the CINeMA approach. Statistical analyses were performed using R 4.2.0., GeMTC package, and JAGS 4.3.1. The review protocol was registered in PROSPERO (registration number: CRD42022333270). Thirteen randomized controlled trials were included in the qualitative synthesis and twelve randomized controlled trials (2395 participants) were included in the network meta-analysis. Over 50% of the included studies were conducted in medical-surgical intensive care units. Ten treatments were analyzed and 12 pairwise comparisons were conducted in the 12 included studies. Analysis using surface under the cumulative ranking curves revealed that brushing combined with chlorhexidine 0.12% was most likely the optimal intervention for preventing ventilator-associated pneumonia (88.4%), followed by the use of chlorhexidine 0.12% alone (76.1%), and brushing alone (73.2%). Oral hygiene care methods that included brushing had high rankings. In conclusion, brushing combined with chlorhexidine 0.12% may be an effective intervention for preventing ventilator-associated pneumonia in critically ill patients. Furthermore, brushing may be the optimal oral hygiene care method for preventing ventilator-associated pneumonia in the intensive care unit. Further research is needed to verify these findings as the CINeMA confidence rate was low for each comparison.
口腔卫生护理对于预防呼吸机相关性肺炎很重要。然而，最佳的口腔卫生护理方法仍不明确。进行了一项网状Meta分析，以比较各种口腔卫生护理方法在预防重症患者呼吸机相关性肺炎方面的疗效，并对这些方法进行了排名。对三个代表性数据库进行了文献检索。我们仅分析了为分析在重症监护病房接受有创机械通气的成年患者口腔卫生护理中使用防腐剂或牙刷而进行的平行随机对照试验。结局指标是呼吸机相关性肺炎的发生率。使用Cochrane偏倚风险2工具评估偏倚风险，并使用CINeMA方法评估证据的可信度。使用R 4.2.0、GeMTC软件包和JAGS 4.3.1进行统计分析。该综述方案已在PROSPERO中注册（注册号：CRD42022333270）。定性综合分析纳入了13项随机对照试验，网状Meta分析纳入了12项随机对照试验（2395名参与者）。超过50%的纳入研究是在外科重症监护病房进行的。在纳入的12项研究中分析了10种治疗方法并进行了12次成对比较。使用累积排名曲线下面积分析表明，0.12%洗必泰联合刷牙最有可能是预防呼吸机相关性肺炎的最佳干预措施（88.4%），其次是单独使用0.12%洗必泰（76.1%）和单独刷牙（73.2%）。包括刷牙的口腔卫生护理方法排名较高。总之，0.12%洗必泰联合刷牙可能是预防重症患者呼吸机相关性肺炎的有效干预措施。此外，刷牙可能是重症监护病房预防呼吸机相关性肺炎的最佳口腔卫生护理方法。由于每次比较的CINeMA可信度较低，需要进一步研究来验证这些发现。
