BMJ, doi: 10.1136/bmj.39136.528160.BE, (Published 26 March 2007)

RESEARCH

Oral decontamination for prevention of pneumonia in mechanically ventilated adults: systematic review and meta-analysis

Ee Yuee Chan 1*, Annie Ruest 2, Maureen O Meade 3, Deborah J Cook 3

1 Department of Nursing Services, Tan Tock Seng Hospital, Singapore
2 Centre Hospitalier Universitaire de Québec-Hôtel-Dieu, Departments of Medicine and Medical Biology, Québec, Canada
3 Departments of Medicine, Clinical Epidemiology, and Biostatistics, McMaster University, Hamilton, Canada

* Correspondence to: ee_yuee_chan{at}ttsh.com.sg.

Objective To evaluate the effect of oral decontamination on the incidence of ventilator associated pneumonia and mortality in mechanically ventilated adults.

Design Systematic review and meta-analysis.

Data sources Medline, Embase, CINAHL, the Cochrane Library, trials registers, reference lists, conference proceedings, and investigators in the specialty.

Review methods Two independent reviewers screened studies for inclusion, assessed trial quality, and extracted data. Eligible trials were randomised controlled trials enrolling mechanically ventilated adults that compared the effects of daily oral application of antibiotics or antiseptics with no prophylaxis.

Results 11 trials totalling 3242 patients met the inclusion criteria. Among four trials with 1098 patients, oral application of antibiotics did not significantly reduce the incidence of ventilator associated pneumonia (relative risk 0.69, 95% confidence interval 0.41 to 1.18). In seven trials with 2144 patients, however, oral application of antiseptics significantly reduced the incidence of ventilator associated pneumonia (0.56, 0.39 to 0.81). When the results of the 11 trials were pooled, rates of ventilator associated pneumonia were lower among patients receiving either method of oral decontamination (0.61, 0.45 to 0.82). Mortality was not influenced by prophylaxis with either antibiotics (0.94, 0.73 to 1.21) or antiseptics (0.96, 0.69 to 1.33) nor was duration of mechanical ventilation or stay in the intensive care unit.

Conclusions Oral decontamination of mechanically ventilated adults using antiseptics is associated with a lower risk of ventilator associated pneumonia. Neither antiseptic nor antibiotic oral decontamination reduced mortality or duration of mechanical ventilation or stay in the intensive care unit.

(Accepted 28 January 2007)
Add to CiteULike CiteULike   Add to Complore Complore   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Reddit Reddit   Add to StumbleUpon StumbleUpon   Add to Technorati Technorati    What's this?

Relevant Articles

Subgroup analyses: how to avoid being misled
John Fletcher
BMJ 2007 335: 96-97. [Extract] [Full Text] [PDF]

Oral decontamination treats the symptom, not the cause
Duncan L Wyncoll and Peter J Young
BMJ 2007 334: 967-968. [Extract] [Full Text] [PDF]

Preventing ventilator associated pneumonia
Christian Brun-Buisson
BMJ 2007 334: 861-862. [Extract] [Full Text] [PDF]

How strong is the evidence for the use of perioperative {beta} blockers in non-cardiac surgery? Systematic review and meta-analysis of randomised controlled trials
P J Devereaux, W Scott Beattie, Peter T-L Choi, Neal H Badner, Gordon H Guyatt, Juan C Villar, Claudio S Cinà, Kate Leslie, Michael J Jacka, Victor M Montori, Mohit Bhandari, Alvaro Avezum, Alexandre B Cavalcanti, Julian W Giles, Thomas Schricker, Homer Yang, Carl-Johan Jakobsen, and Salim Yusuf
BMJ 2005 331: 313-321. [Abstract] [Full Text] [PDF]

Measuring inconsistency in meta-analyses
Julian P T Higgins, Simon G Thompson, Jonathan J Deeks, and Douglas G Altman
BMJ 2003 327: 557-560. [Extract] [Full Text] [PDF]

Statistics Notes: Interaction revisited: the difference between two estimates
Douglas G Altman and J Martin Bland
BMJ 2003 326: 219. [Extract] [Full Text] [PDF]

Effectiveness of antibiotic prophylaxis in critically ill adult patients: systematic review of randomised controlled trials
Roberto D'Amico, Silvia Pifferi, Cinzia Leonetti, Valter Torri, Angelo Tinazzi, and Alessandro Liberati
BMJ 1998 316: 1275-1285. [Abstract] [Full Text] [PDF]

This article has been cited by other articles:

  • Pobo, A., Lisboa, T., Rodriguez, A., Sole, R., Magret, M., Trefler, S., Gomez, F., Rello, J., for the RASPALL Study Investigators, (2009). A Randomized Trial of Dental Brushing for Preventing Ventilator-Associated Pneumonia. Chest 136: 433-439 [Abstract] [Full text]  
  • Pedreira, M. L.G., Kusahara, D. M., de Carvalho, W. B., Nunez, S. C., Peterlini, M. A. S. (2009). Oral Care Interventions and Oropharyngeal Colonization in Children Receiving Mechanical Ventilation. Am J Crit Care 18: 319-328 [Abstract] [Full text]  
  • Dallas, J., Kollef, M. (2009). Oral Decontamination to Prevent Ventilator-Associated Pneumonia: Is It a Sound Strategy?. Chest 135: 1116-1118 [Full text]  
  • de Smet, A.M.G.A., Kluytmans, J.A.J.W., Cooper, B.S., Mascini, E.M., Benus, R.F.J., van der Werf, T.S., van der Hoeven, J.G., Pickkers, P., Bogaers-Hofman, D., van der Meer, N.J.M., Bernards, A.T., Kuijper, E.J., Joore, J.C.A., Leverstein-van Hall, M.A., Bindels, A.J.G.H., Jansz, A.R., Wesselink, R.M.J., de Jongh, B.M., Dennesen, P.J.W., van Asselt, G.J., te Velde, L.F., Frenay, I.H.M.E., Kaasjager, K., Bosch, F.H., van Iterson, M., Thijsen, S.F.T., Kluge, G.H., Pauw, W., de Vries, J.W., Kaan, J.A., Arends, J.P., Aarts, L.P.H.J., Sturm, P.D.J., Harinck, H.I.J., Voss, A., Uijtendaal, E.V., Blok, H.E.M., Thieme Groen, E.S., Pouw, M.E., Kalkman, C.J., Bonten, M.J.M. (2009). Decontamination of the Digestive Tract and Oropharynx in ICU Patients. NEJM 360: 20-31 [Abstract] [Full text]  
  • Hurley, J. C. (2008). Profound effect of study design factors on ventilator-associated pneumonia incidence of prevention studies: benchmarking the literature experience. J Antimicrob Chemother 61: 1154-1161 [Abstract] [Full text]  
  • Nseir, S. (2008). From the authors. Eur Respir J 31: 221-222 [Full text]  
  • Fletcher, J. (2007). Subgroup analyses: how to avoid being misled. BMJ 335: 96-97 [Full text]  
  • (2007). Oral Decontamination and VAP. JWatch Infect. Diseases 2007: 2-2 [Full text]  
  • Wyncoll, D. L, Young, P. J (2007). Oral decontamination treats the symptom, not the cause. BMJ 334: 967-968 [Full text]  
  • Brun-Buisson, C. (2007). Preventing ventilator associated pneumonia. BMJ 334: 861-862 [Full text]  

Rapid Responses:

Read all Rapid Responses

Antiseptics (rather than antibiotics) should be used for decontamination to prevent ventilator associated pneumonia
Paula J Whittaker, et al.
bmj.com, 25 Apr 2007 [Full text]
Oral chlorhexidine better than oropharyngeal topical antibiotics in the prevention of pneumonia during mechanical ventilation. A message hard to swallow.
Luciano Silvestri, et al.
bmj.com, 21 Nov 2007 [Full text]
Considering antiseptic oral decontamination to reduce ventilator-associated pneumonia
Ee Yuee Chan, et al.
bmj.com, 13 Dec 2007 [Full text]
Access jobs at BMJ Careers
Whats new online at Student BMJ