Effect of different mouthwashes on ventilator-related outcomes and mortality in intensive care unit patients: A network meta-analysis
Abstract
BACKGROUND
Ventilator-associated pneumonia is a common and life-threatening complication in intensive care unit (ICU) patients. Maintaining oral hygiene is crucial for reducing ventilator-associated pneumonia incidence. Various mouthwash solutions are used for oral care in ICU settings, but their comparative effectiveness remains unclear. This study aims to systematically evaluate and compare the efficacy and safety of commonly used mouthwashes for oral care in mechanically ventilated ICU patients.
METHODS
We searched PubMed, Web of Science, Embase, and Cochrane Library for randomised controlled trials (RCTs) comparing saline, chlorhexidine, sodium bicarbonate, oxidising agents, herbal extracts, and povidone-iodine for oral care in ventilated ICU patients. Outcomes included ventilator-associated pneumonia incidence, ICU mortality, duration of ventilation, and Escherichia coli fixed value. A network meta-analysis (NMA) was conducted to synthesise direct and indirect evidence. This study is registered with the International Platform of Registered Systematic Review and Meta-analysis Protocols, 2023120028.
RESULTS
FourteenRCTs with 1644 participants were included. Oxidising agents showed a trend towards reducing the incidence of VAP compared to the control group (risk ratio: 0.24, 95% confidence interval: 0.05-1.10). Administration of saline was associated with a notable reduction in ICU mortality (risk ratio: 0.18, 95% confidence interval: 0.04-0.88) versus no mouthwash. No…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 1,644 participants or records.
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