【BMJ】口腔脱污染，预防呼吸机肺炎的META分析和系统评价

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Oral decontamination for prevention of pneumonia in mechanically ventilated adults: systematic review and meta-analysis

Ee Yuee Chan, nurse educator,1 Annie Ruest, infectious diseases consultant ,2 Maureen O Meade, associate
professor,3 Deborah J Cook, professor3

1Department of Nursing Services,
Tan Tock Seng Hospital, Singapore
2Centre Hospitalier Universitaire
de Québec-Hôtel-Dieu,
Departments of Medicine and
Medical Biology, Québec, Canada
3Departments of Medicine, Clinical
Epidemiology, and Biostatistics,
McMaster University, Hamilton,
Canada
Correspondence to: E Y Chan
ee_yuee_chan@ttsh.com.sg
doi: 10.1136/bmj.39136.528160.BE

ABSTRACT
Objective To evaluate the effect of oral decontamination
on the incidence of ventilator associated pneumonia and
mortality in mechanically ventilated adults.
Design Systematic review and meta-analysis.
Data sources Medline, Embase, CINAHL, the Cochrane
Library, trials registers, reference lists, conference
proceedings, and investigators in the specialty.
Review methods Two independent reviewers screened
studies for inclusion, assessed trial quality, and extracted
data. Eligible trials were randomised controlled trials
enrolling mechanically ventilated adults that compared
the effects of daily oral application of antibiotics or
antiseptics with no prophylaxis.
Results 11 trials totalling 3242 patients met the inclusion
criteria. Among four trials with 1098 patients, oral
application of antibiotics did not significantly reduce the
incidence of ventilator associated pneumonia (relative
risk 0.69, 95% confidence interval 0.41 to 1.18). In seven
trials with 2144 patients, however, oral application of
antiseptics significantly reduced the incidence of
ventilator associated pneumonia (0.56, 0.39 to 0.81).
When the results of the 11 trials were pooled, rates of
ventilator associated pneumonia were lower among
patients receiving either method of oral decontamination
(0.61, 0.45 to 0.82). Mortality was not influenced by
prophylaxis with either antibiotics (0.94, 0.73 to 1.21) or
antiseptics (0.96, 0.69 to 1.33) nor was duration of
mechanical ventilation or stay in the intensive care unit.
Conclusions Oral decontamination of mechanically
ventilated adults using antiseptics is associated with a
lower risk of ventilator associated pneumonia. Neither
antiseptic nor antibiotic oral decontamination reduced
mortality or duration of mechanical ventilation or stay in
the intensive care unit.