Oral topical decontamination for preventing ventilator-associated pneumonia: a systematic review and meta-analysis of randomized controlled trials

Background: Oral decontamination is proposed to be an effective prevention of ventilator-associated pneumonia (VAP). Aim: The objective of this paper was to evaluate the effectiveness of oral decontamination in adult patients undergoing ventilation for more than 48 h. Methods: We included all randomized controlled trials that used oral topical decontamination in adult patients from any population requiring mechanical ventilation for more than 48 h, versus placebo, normal saline, or standard oral care. Findings: Sixteen trials involving 2399 participants were included. Meta-analysis showed that oral topical antiseptics significantly reduced the incidence of VAP [risk ratio (RR): 0.66; 95% confidence interval (CI): 0.49-0.88]. There was a significant reduction of VAP in studies which investigated decontamination with antibiotic agents other than iseganan (RR: 0.27; 95% CI: 0.18-0.42). Neither antiseptics nor antibiotics affected all-cause mortality, duration of ventilation, or duration of intensive care unit (ICU) stay. Conclusion: Oral decontamination reduced the incidence of VAP in adults undergoing ventilation, but did not affect all-cause mortality, duration of ventilation, or duration of ICU stay in ventilated patients. Further evidence from higher quality trials is necessary. Crown Copyright (c) 2013 Published by Elsevier Ltd on behalf of the Healthcare Infection Society. All rights reserved.