Uso associado de escovação dentária e clorexidina comparado ao uso exclusivo de clorexidina para prevenção de pneumonia associada à ventilação mecânica: revisão sistemática e metanálise da literatura

Abstract

Ventilator-associated pneumonia (VAP) is a pulmonary infection that develops in a patient on mechanical ventilation for more than 48 hours. It is the most common lower respiratory tract infection in mechanically ventilated patients. Oral hygiene is an important factor in preventing VAP. Chlorhexidine is an antiseptic with bacteriostatic and bactericidal effect, and its effect can be potentiated by mechanical removal of microorganisms through tooth brushing. The aim of this study was to compare the efficacy of 0.12% chlorhexidine versus 0.12% chlorhexidine associated with mechanical brushing to prevent VAP. However, a systematic review of randomized controlled trials was initially performed following the PRISMA-P and Cochrane guidelines. Then, a meta-analysis was performed with publications that reported the frequency of VAP in the interest groups of this study. Initially, 2,337 studies were identified, four of which were considered in the systematic review and three in the meta-analysis. The included studies had a low risk of bias. All studies considered in the systematic review showed a lower frequency of VAP in patients undergoing chlorhexidine-associated oral hygiene protocol compared to the exclusive use of chlorhexidine, but in none of them this difference was statistically significant. In the meta-analysis, aggregated results revealed that the risk of VAP was 24% lower for patients receiving CHX and tooth brushing compared with those receiving CHX alone, but this reduction was not statistically significant either. Conclusion: There was convergence of study results regarding the beneficial effect of combined use of brushing and chlorhexidine, however the aggregated results of these studies did not result in significant difference in VAP frequency.