Summary of findings 2. Toothbrushing (± antiseptics) versus no toothbrushing (± antiseptics) for critically ill patients to prevent ventilator‐associated pneumonia.
| Toothbrushing (± antiseptics) versus no toothbrushing (± antiseptics) for critically ill patients to prevent ventilator‐associated pneumonia (VAP) | ||||||
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Patient or population: critically ill patients receiving mechanical ventilation
Settings: intensive care units (ICUs)
Intervention: toothbrushing (± chlorhexidine) Comparison: no toothbrushing (± chlorhexidine) | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No. of participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
| No toothbrushing | Toothbrushing | |||||
|
Incidence of VAP Follow‐up: mean 1 month |
367 per 10001 | 253 per 1000 (161 to 400) | RR 0.69 (0.44 to 1.09) | 889 (5 studies)2 | ⊕⊝⊝⊝ very low3 | |
| Mortality Follow‐up: mean 1 month | 236 per 10001 | 205 per 1000 (165 to 257) | RR 0.87 (0.70 to 1.09) | 889 (5 studies)2 | ⊕⊕⊝⊝ low4 | |
| Duration of ventilation Follow‐up: mean 1 month | The mean duration of ventilation in the control groups ranged from 9.8 to 10 days | The mean duration of ventilation in the intervention groups was 0.11 days fewer (0.90 fewer to 0.68 more) | 644 (3 studies) | ⊕⊕⊝⊝ low5 | ||
| Duration of ICU stay Follow‐up: mean 1 month | The mean duration of ICU stay in the control groups ranged from 13 to 15 days | The mean duration of ICU stay in the intervention groups was 1.82 days fewer (3.95 fewer to 0.32 more) | 583 (2 studies) | ⊕⊝⊝⊝ very low6 | ||
| Adverse effects | Most of the studies did not provide information on adverse events. Information on adverse events was identified from one study which stated there was none. | ⊕⊝⊝⊝ very low7 | ||||
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI) CI: confidence interval; RR: risk ratio | ||||||
| GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate Very low quality: We are very uncertain about the estimate | ||||||
1Assumed risk is based on the outcomes in the control groups of the included studies 2Three studies compared toothbrushing + chlorhexidine with chlorhexidine alone, one study compared toothbrushing with no toothbrushing (no chlorhexidine in either group), another study compared toothbrushing + povidone iodine with povidone iodine alone. 3Downgraded three levels due to serious imprecision, substantial heterogeneity (I2 = 64%) and very serious risk of bias: five studies at high risk of bias. 4Downgraded two levels due to very serious risk of bias: five studies at high risk of bias. 5Downgraded two levels due to very serious risk of bias: three studies at high risk of bias. 6Downgraded three levels due to very serious imprecision and serious risk of bias: two studies at high risk of bias. 7Downgraded three levels due to very serious imprecision and serious inconsistency: only one study reported on this outcome, with data which did not enable us to evaluate the risk of adverse events.