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. 2020 Dec 24;2020(12):CD008367. doi: 10.1002/14651858.CD008367.pub4

Comparison 1. Chlorhexidine versus placebo/usual care.

Outcome or subgroup title No. of studies No. of participants Statistical method Effect size
1.1 Incidence of VAP 13 1206 Risk Ratio (M‐H, Random, 95% CI) 0.67 [0.47, 0.97]
1.1.1 Chlorhexidine solution versus placebo (no toothbrushing in either group) 6 429 Risk Ratio (M‐H, Random, 95% CI) 0.57 [0.33, 1.00]
1.1.2 Chlorhexidine gel versus placebo (no toothbrushing in either group) 2 297 Risk Ratio (M‐H, Random, 95% CI) 0.53 [0.29, 0.97]
1.1.3 Chlorhexidine solution versus placebo (toothbrushing both groups) 3 332 Risk Ratio (M‐H, Random, 95% CI) 0.74 [0.29, 1.89]
1.1.4 Chlorhexidine gel versus placebo (toothbrushing both groups) 2 148 Risk Ratio (M‐H, Random, 95% CI) 1.22 [0.83, 1.79]
1.2 Mortality 9 944 Risk Ratio (M‐H, Random, 95% CI) 1.02 [0.84, 1.23]
1.2.1 Chlorhexidine solution versus placebo (no toothbrushing in either group) 4 374 Risk Ratio (M‐H, Random, 95% CI) 1.03 [0.80, 1.33]
1.2.2 Chlorhexidine gel versus placebo (no toothbrushing in either group) 1 40 Risk Ratio (M‐H, Random, 95% CI) Not estimable
1.2.3 Chlorhexidine solution versus placebo (toothbrushing both groups) 2 382 Risk Ratio (M‐H, Random, 95% CI) 1.00 [0.72, 1.40]
1.2.4 Chlorhexidine gel versus placebo (toothbrushing both groups) 2 148 Risk Ratio (M‐H, Random, 95% CI) 1.00 [0.59, 1.68]
1.3 Duration of ventilation (days) 4 594 Mean Difference (IV, Random, 95% CI) ‐1.10 [‐3.20, 1.00]
1.3.1 Chlorhexidine solution versus placebo (no toothbrushing in either group) 3 263 Mean Difference (IV, Random, 95% CI) ‐2.63 [‐3.35, ‐1.90]
1.3.2 Chlorhexidine gel versus placebo (no toothbrushing in either group) 1 257 Mean Difference (IV, Random, 95% CI) 2.21 [‐0.30, 4.72]
1.3.3 Chlorhexidine solution versus placebo (toothbrushing both groups) 1 74 Mean Difference (IV, Random, 95% CI) ‐1.30 [‐4.20, 1.60]
1.4 Duration of ICU stay (days) 5 627 Mean Difference (IV, Random, 95% CI) ‐0.89 [‐3.59, 1.82]
1.4.1 Chlorhexidine solution versus placebo (no toothbrushing in either group) 3 274 Mean Difference (IV, Random, 95% CI) ‐2.92 [‐4.18, ‐1.66]
1.4.2 Chlorhexidine gel versus placebo (no toothbrushing in either group) 1 257 Mean Difference (IV, Random, 95% CI) 1.32 [‐2.43, 5.07]
1.4.3 Chlorhexidine gel versus placebo (toothbrushing both groups) 1 96 Mean Difference (IV, Random, 95% CI) 5.00 [‐2.20, 12.20]
1.5 Duration of systemic antibiotic therapy (days) 1 146 Mean Difference (IV, Fixed, 95% CI) 0.65 [‐0.58, 1.88]
1.5.1 Chlorhexidine solution versus placebo (toothbrushing both groups) 1 146 Mean Difference (IV, Fixed, 95% CI) 0.65 [‐0.58, 1.88]
1.6 Number of participants treated with systemic antibiotics 1   Risk Ratio (M‐H, Fixed, 95% CI) Subtotals only
1.6.1 Chlorhexidine solution versus placebo (no toothbrushing in either group) 1 16 Risk Ratio (M‐H, Fixed, 95% CI) 0.86 [0.53, 1.38]
1.7 Plaque index 2   Std. Mean Difference (IV, Fixed, 95% CI) Totals not selected
1.7.1 Chlorhexidine solution versus placebo (no toothbrushing in either group) 2   Std. Mean Difference (IV, Fixed, 95% CI) Totals not selected
1.8 Adverse effects 1   Risk Ratio (M‐H, Fixed, 95% CI) Subtotals only
1.8.1 Reversible mild irritation of oral mucosa 1 207 Risk Ratio (M‐H, Fixed, 95% CI) 10.29 [1.34, 78.97]