A clorexidina deve ser mantida dentro dos pacotes para prevenção de Pneumonia Associada à Ventilação Mecânica?

Abstract

Ventilator-associated pneumonia is the most common infection in intensive care units and is associated with high morbidity and mortality rates. The chlorhexidine use in the critically ill patients oral care to prevent this infection has low scientific evidence level and the information available in the literature is controversial. The purpose of this review was verify whether the adverse effects of this substance outweight its benefits and assess the need for alternative strategies for its use. Articles in Portuguese, English or Spanish, conducted in adult population, were searched in Excerpta Medica Database (EMBASE), PubMED/Medline, Biblioteca Virtual em Saúde, SciELO, Cochrane Library, Scopus, ScienceDirect, BioMed Central, Web of Science. Guidelines, review articles, clinical trials, cohort studies, comparative studies, case series and descriptive studies were included. We used prospective, retrospective or cross-sectional studies and those without the full text were excluded. After review, eligible studies were selected for methodological quality assessment. Narrative description was employed in data analysis to summarize the results. The findings show that oral care with chlorhexidine is associated with a higher ventilation associated events and mortality risk. According to the authors's speculations, chlorhexidine digluconate, which is an acid salt, can cause damage in various organic sectors and cytotoxicity. Based on that, recent international protocols removed from their bundles the recommendation for its use and reported that further studies are necessary to provide for the critically ill patient a safer and better quality health service.