Table 1.
Main characteristics of randomized controlled trials included in the meta-analysis of toothbrushing for ventilator-associated pneumonia prevention
| Author/Year | Number of patients (I/C) | Type of ICU/Study population | Severity of illness (I/C) | Intervention group | Control group | Definition of VAP | Study design/Jadad score | Funding bias |
Length of follow-up, days | Rate of successful follow-up |
|---|---|---|---|---|---|---|---|---|---|---|
| Munro et al. [20] (2009) | 192 (97/95) | Medical-surgical/adult patients requiring MV > 24 hours, with no current pneumonia | APACHE III score: 76.4 ± 23.3/76.2 ± 3.3 and 76.2 ± 25.5/80.4 ± 28.7 | 0.12% CHX and toothbrushing (that is, soft pediatric toothbrush and toothpaste; brushing tooth by tooth, on anterior and posterior surfaces, the palate, and the tongue) | 0.12% CHX 5 mL by oral swab twice daily or usual care |
CPIS > 6 | Non-blind, RCT/2 | No | 3 | 46% |
| Pobo et al. [21] (2009) | 147 (74/73) | Surgical/adult patients requiring MV > 48 hours, with no current pneumonia | APACHE II score: 18.8 ± 7.1/18.7 ± 7.3 | 0.12% CHX and toothbrushing every 8 hours (that is, electric toothbrush; brushing tooth by tooth, on anterior and posterior surfaces, the gum line, and the tongue) | Oral care every 8 hours with 0.12% CHX | New or progressive pulmonary opacities together with purulent respiratory secretions plus fever > 38°C or leukocytosis > 10,000 cells/mL | Single-blind, RCT/3 | No | 28 | 100% |
| Yao et al. [22] (2011) | 53 (28/25) | Medical-surgical/adult patients requiring MV > 48 to 72 hours, with no current pneumonia | APACHE II score: 19.6 ± 5.2/19.4 ± 4.4 | Usual care using cotton swabs, elevating the head of the bed, moisturizing the lips, and before-and-after hypopharyngeal suctioning; toothbrushing (that is, electric and soft pediatric toothbrush; brushing tooth with purified water, teeth facial sides cleansed with electric toothbrush, and lingual sides, gums, mucosa, and tongue cleansed with pediatric toothbrush) | Usual care using cotton swabs, elevating the head of the bed, moisturizing the lips, and before-and-after hypopharyngeal suctioning | CPIS > 6 | Single-blind, pilot, RCT/3 | No | 9 | 68% |
| Lorente et al. [23] (2012) | 436 (217/219) | Medical, surgical/trauma, and neuroscience/adult patients requiring MV > 24 hours, with no current pneumonia | APACHE II score: 17.88 ± 8.84/19.16 ± 9.88 | 0.12% CHX and toothbrushing (that is, manually brushing tooth by tooth, on the anterior and posterior surfaces, the gum line, and the tongue for a period of 90 seconds) | Oral cleansing every 8 hours with 0.12% CHX | New onset of bronchial purulent sputum; body temperature > 38°C or < 35.5°C; white blood cell count > 10,000/mm3 or < 4,000/mm3; chest radiograph showing new or progressive infiltrates; significant quantitative culture of respiratory secretions by tracheal aspirate (> 106 CFU/mL) | Single-blind, RCT/3 | No | Not reported | 100% |
APACHE, Acute Physiology and Chronic Health Evaluation; CFU, colony-forming units; CHX, chlorhexidine; CPIS, clinical pulmonary infection score; I/C, intervention/control; ICU, intensive care unit; MV, mechanical ventilation; RCT, randomized controlled trial; VAP, ventilator-associated pneumonia.