Comparative efficacy of different concentrations of chlorhexidine for prevention of ventilator‐associated pneumonia in intensive care units: A systematic review and network meta‐analysis

作者：Yang Li, Qin Zhang, Huaixiang Zhai · 发表于：Nursing in Critical Care · 年份：2022 · DOI：10.1111/nicc.12849 · 被引用次数：2 · 研究领域：Nosocomial Infections in ICU、Pneumonia and Respiratory Infections、Respiratory Support and Mechanisms

Abstract Background Ventilator‐associated pneumonia is a common type of hospital‐acquired infection in critically ill patients. The implementation of effective oral care with chlorhexidine is known to be an effective intervention to prevent ventilator‐associated pneumonia. Nonetheless, no well‐supported evidence exists yet to rank the efficacy of various concentrations of chlorhexidine. Aim To compare the efficacy of different concentrations of chlorhexidine (0.12%, 0.20% and 2.0%) for prevention of ventilator‐associated pneumonia. Study Design Electronic databases, as well as bibliographies, were systematically searched to find relevant studies published in English from inception until January 1, 2022. We included randomized controlled trials of mechanically ventilated adult patients in intensive care settings comparing at least two of the following treatments: 0.12% chlorhexidine, 0.2% chlorhexidine, 2.0% chlorhexidine, or placebo. The selected outcome was the incidence of ventilator‐associated pneumonia. A frequentist network meta‐analysis was performed. We ranked the concentrations of chlorhexidine for the selected outcome by p score (estimate of the probability of being the best treatment). Results We included 19 trials with 3183 participants, conducted across nine countries. The use of 2.0% chlorhexidine and 0.12% chlorhexidine decreased the risk of ventilator‐associated pneumonia compared with placebo (OR 0.46, 95% CI = 0.28–0.75; OR 0.49, 95% CI = 0.33–0.71, respectiv...