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 Staphylococcus aureus (MRSA) |
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 (p < 0.01) |
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 (p=0.084) |
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 (p < 0.001) |
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 (p = 0.243). |