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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Population: critically ill adults receiving mechanical ventilation
Setting: intensive care units (ICUs)
Intervention: toothbrushing (± antiseptics) Comparison: no toothbrushing (± antiseptics) | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | Number of participants (studies) | Certainty of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
| No toothbrushing | Toothbrushing | |||||
|
Incidence of VAP Follow‐up: mean 1 month |
259 per 10001 | 179 per 1000 (106 to 236) | RR 0.61 (0.41 to 0.91) | 910 (5 studies)2 | ⊕⊕⊝⊝ low3 | There may be a reduction in the incidence of VAP |
| Mortality Follow‐up: mean 1 month | 250 per 10001 | 210 per 1000 (168 to 263) | RR 0.84 (0.67 to 1.05) | 910 (5 studies)2 | ⊕⊕⊝⊝ low4 | The evidence does not show a difference in mortality |
| Duration of ventilation Follow‐up: mean 1 month | The mean duration of ventilation in the control groups ranged from 10 to 11 days | The mean duration of ventilation in the intervention groups was 0.43days fewer (1.17 fewer to 0.30 more) | 810 (4 studies) | ⊕⊕⊝⊝ low5 | The evidence does not show a difference in duration of ventilation | |
| Duration of ICU stay Follow‐up: mean 1 month | The mean duration of ICU stay in the control groups ranged from 13 to 16 days | The mean duration of ICU stay in the intervention groups was 1.89days fewer (3.52 fewer to 0.27 fewer) | 749 (3 studies) | ⊕⊝⊝⊝ very low6 | There may be a reduction in the duration of ICU stay | |
| Adverse effects | Most of the studies did not provide information on adverse events. Information on adverse events was identified from two studies, which stated that there were none. | ⊕⊝⊝⊝ very low7 | There is a lack of evidence about adverse effects. | |||
| *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 certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: we are moderately confident in the effect estimate; the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited; the true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate; the true effect is likely to be substantially different from the estimate of effect. | ||||||
1Assumed risk was based on the outcomes in the control groups of the included studies. 2Four 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 two levels due to 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: four studies at high risk of bias. 6Downgraded three levels due to serious imprecision and very serious risk of bias: three studies at high risk of bias. 7Downgraded three levels due to very serious imprecision and serious inconsistency: only two studies reported on this outcome, with data that did not enable us to evaluate the risk of adverse events.