Implications for practice and research

• This meta-analysis suggests that oral care with chlorhexidine may lower risk for ventilator-associated pneumonia (VAP).

• The meta-analysis did not include important outcomes such as mortality and length of stay.

• Recent analyses suggest that oral chlorhexidine may increase mortality risk.

• More data are needed to support chlorhexidine use.

• Providers are advised to focus their VAP prevention efforts on other strategies that are more consistently associated with better patient outcomes such as minimising sedation, daily spontaneous awakening and breathing trials, early mobility, continuous aspiration of subglottic secretions, and head-of-bed elevation.

Context

Intubation and mechanical ventilation increase patients’ risk for pneumonia. The endotracheal tube facilitates microbial colonisation of the oropharynx and passage of oral secretions from the oropharynx to the lungs. Routine oral …