Prevention of Pneumonia due to Ventilator in Critical Patients with U Shape Oral Hygiene Model: A Systematic Review
, , and | Apr 20, 2023
About this article
Article Category: Review
Published Online: Apr 20, 2023
Page range: 1 - 9
DOI: https://doi.org/10.2478/rjaic-2023-0001
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© 2023 Nova Maryani et al., published by sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.
Figure 1.
Figure 2.
A summary of the characteristic result of the included studies on the use of toothbrushing in oral care for ventilated patients.
| No. | Author & Date | Treatment | Subject | Methodology | Intervention | Control Group | Outcome |
|---|---|---|---|---|---|---|---|
| 1 | Snyders et al., (2011) | Oral care with chlorhexidine | 1930 adult patients with ventilator | Meta-analysis | Chlorohexidine 0.12% and chlorohexidine 2% concentration | Placebo, toothbrushing, oral rinse, Listerine | Chlorohexidine showed a beneficial effect in preventing VAP with a 2% dose being the most effective |
| 2 | Grap et al. (2011) | Chlorhexidine | 145 trauma patients with ventilator | Randomised controlled trial | 5 ml chlorhexidine | Oral care without chlorhexidine | In trauma patients, chlorohexidine may significantly reduce VAP and a single swab can be useful as an alternative way to reduce VAP |
| 3 | Tuon et al. (2016) | Chlorohexidine | 16 patients with ventilator | Randomised controlled trial (double-blind) | Oral washing with 15 ml of 2% chlorohexidine gluconate | Placebo (mouth washing using 0.9% NaCl solution) | When compared to the control group, the intervention group had a minimal incidence of methicillin-resistant |
| 4 | Cutler & Sluman (2014) | Toothbrushing and chlorohexidine | 528 ventilated patients | A historical controlled study | Toothbrushing and 1% chlorohexidine | - | The expected and observed incidence of VAP after a change in oral care indicated a statistically significant difference ( |
| 5 | Kusahara et al. (2012) | Chlorhexidine | 96 paediatric patients with ventilator | Prospective, RCT, double-blind clinical trial | 46 participants used a toothbrush and antibacterial gel twice daily (chlorohexidine) | 50 placebo samples were brushed with non-antiseptic gel for 12 hours. | In a sample of children on mechanical ventilation, 0.12% chlorohexidine revealed insignificance to reduce the prevalence of VAP |
| 6 | Silva et al. (2021) | Toothbrushing and chlorhexidine | 796 patients | Meta-analysis | Chlorohexidine with toothbrushing | Chlorohexidine | Based on meta-analysis, chlorohexidine effects a lower risk of VAP incidence than chlorohexidine alone |
| 7 | Ory et al. (2016) | Toothbrushing | 2,030 ventilated patients in ICU | Cohort study | Caregiver using foam stick in period 1 (chlorohexidine) | Caregiver using stick and toothbrushing with aspiration (chlorohexidine) | Oral health improved considerably from the third day of intervention with a toothbrush in period 2. The probability of VAP decreased significantly between the two periods |
| 8 | Conley et al., (2013) | Toothbrushing using toothpaste and CHG | 75 patients with ventilator | Prospective study RCT | Brushing teeth with toothpaste and using 0.12% chlorohexidine gluconate solution every 12 hours | - | Toothbrushing with toothpaste and applying chlorohexidine gluconate may be effective in reducing the VAP rate |
| 9 | de Lacerda Vidal et al. (2017) | Toothbrushing and chlorhexidine | 213 patients with ventilator | Prospective RCT | Toothbrushing with 0.12% chlorohexidine gel every 12 hours | 0.12% chlorohexidine every 12 hours | The brushing combined with 0.12% chlorhexidine gel minimised the prevalence of VAP during the follow-up period, however, the deviation was statistically insignificant ( |
| 10 | Sankaran & Sonis (2021) | Toothbrushing | 4473 patients | Meta-analysis | 0.12% Chlorohexidine, bicarbonate rinse + toothbrushing, Listerine, furacilin, povidone-iodine | Placebo/usual | The result showed that toothbrushing, brushing teeth with povidone-iodine, and were three oral care interventions that can prevent VAP |
| 11 | Nasiriani et al. (2016) | Toothbrushing | 168 patients with ventilator | Randomised controlled trial | Brushing teeth twice a day with distilled water and a child’s toothbrush | Routine oral care | The findings revealed a substantial difference in the prevalence of VAP on day 5 of intervention between both of the groups |
| 12 | Gu et al. (2012) | Toothbrushing | 828 patients with ventilator | Meta-analysis | Toothbrushing | Without toothbrushing | The intervention was an insignificant effect on minimising mortality of VAP or intensive care unit |
| 13 | Hayashida et al. (2016) | Toothbrushing and cleaning the mucosa | 45 patients with ventilator | Observation with intervention | Toothbrushing, interdental brushing, tongue mucosal surface cleaning, and also irrigation | - | Brushing and washing the mucosa did not minimise oral bacteria, but watering the oral cavity and oropharynx dramatically reduced it to 105 cfu/ml ( |
| 14 | Lorente et al. (2012) | Toothbrushing and CHX | 436 patients with ventilator | Randomised controlled trial | 0.12% chlorohexidine injection into the oral cavity and manual brushing | Injection of 0.12% chlorohexidine into the oral cavity | Statistically, there was an insignificance difference in the prevalence of VAP in both of the groups with brushing vs. without brushing |
| 15 | Berry et al. (2013) | Oral care with mouthwash (Listerine, natrium bicarbonate) | 398 patients with ventilator | A prospective randomised controlled trial | Group B (6.5 g of sodium bicarbonate and 1 L mouthwash in 20 ml sterile water) Group C (20 ml Listerine mouthwash instilled twice a day and sterile water) | Every two hours, rinse your mouth with 20 ml of of water | On day 4, there was an insignificant difference in dental plaque colonisation in both the control and intervention groups ( |