Ask an answerable question (PICO)：
Ventilator-associated pneumonia is a common complication in patients receiving mechanical ventilation. Preventing this complication is crucial during the care process. Chlorhexidine is commonly used in clinical practice to assist with oral care in patients, but its actual effectiveness in preventing ventilator-associated pneumonia needs further investigation. The purpose of this paper is to investigate whether Chlorhexidine can effectively prevent the occurrence of ventilator-associated pneumonia, and to compare its efficacy with other non Chlorhexidine interventions.
The Method and Analysis of Literature Review：
The corresponding keywords according to PICO were, P: Mechanical ventilator、I: Oral care with chlorhexidine、C: Oral care not with chlorhexidine、O: Prevent ventilator-associated pneumonia, and using Mesh Terms and Boolean Logic. Three databases, PubMed, Embase, and CINAHL were searched for meta-analyses, randomized controlled trials (RCTs), or systematic reviews (SRs) and limited to published within the past five years (2018-2023). Mesh terms and Boolean logic (AND, OR) were used to refine the search and ensure relevance. After the initial search, duplicate articles were excluded, and titles and abstracts were reviewed to identify potentially relevant articles. Full texts of these potentially relevant articles were assessed their eligibility for inclusion. One hundred and forty-six articles were excluded, one updated systematic review and one randomized controlled trial were included in this review.
Critical Appraisal：
Level of evidence was assessed based on the Oxford Centre for Evidence-Based Medicine (CEBM) in 2011, with SR classified as Level 1 and RCT as Level 2. The Critical Appraisal Skill Programme (CASP) 2018 Systematic Review Checklist and 2020 RCT Checklist were used as the evaluation tools.
Results, Conclusions and Recommendations：
Results of the SR showed that the use of 0.12%~2% chlorhexidine for oral care can significantly reduce the incidence of ventilator-associated pneumonia, but no significant differences in mortality rate, duration of ventilator use, and ICU length of stay, regardless of whether chlorhexidine was used or not. Results of the RCT indicated that using 0.12% chlorhexidine for oral care three times a day for three consecutive days after intubation was effective to prevent ventilator associated pneumonia and to reduce oral colonization of bacteria, so as the improvement of oral health in mechanically ventilated patients. Based on the synthesis of the two reviewed articles, chlorhexidine, regardless of concentration, is effective in preventing ventilator-associated pneumonia, with higher concentrations (2%) showing the best efficacy. However, long-term use of high-concentration (2%) chlorhexidine may result in adverse effects such as oral mucosal damage, taste alteration, and tongue discoloration. Considering the similar preventive efficacy for clinical application, chlorhexidine at concentrations of 0.12% and 0.2% for oral care, with a frequency of two to four times per day is recommended for patients with mechanical ventilation.
廖玟君*
