Oral hygiene care for critically ill patients on mechanical ventilation
Citation: Zhao T, Wu X, Zhang Q, et al. Oral hygiene care for critically ill patients to prevent ventilator‐associated pneumonia. Cochrane Database of Systematic Reviews. 2020;(12):CD008367. Podcast available in EN / ES / HR.
What is this? Some patients with COVID-19 will become critically ill and require mechanical ventilation in an intensive care unit (ICU). One complication of this is ventilator-associated pneumonia and oral health hygiene, provided by the ICU staff, might help to reduce the risk of this.
In this updated Cochrane review, the authors searched for randomised trials of oral hygiene care in critically ill patients receiving mechanical ventilation for at least 48 hours. They did not restrict their searches by date or language of publication and did the most recent search in March 2020. They included 40 trials (5675 patients) and assessed the risk of bias as high in 31 of these.
What works: Chlorhexidine mouthwash or gel probably reduces the incidence of ventilator‐associated pneumonia in critically ill patients, when compared to placebo or usual care.
Oral hygiene care including both antiseptics and toothbrushing may be more effective than antiseptics alone at reducing the incidence of ventilator‐associated pneumonia and length of stay in ICU.
What doesn’t work: Nothing noted.
What’s uncertain: The limited evidence available for powered versus manual toothbrushing and for other oral hygiene care agents means that the effects of these are uncertain.