Does chlorhexidine reduce the incidence of ventilator-associated pneumonia in ICU patients? A systematic review and meta-analysis

Objective: This study aimed to investigate chlorhexidine's efficacy in preventing ventilator-associated pneumonia (VAP). Design: A systematic review and meta-analysis were conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Settings: The data were obtained from Pubmed, Cochrane Library, and EMBASE. Patients or participants: Only mechanically ventilated patients for at least 48 h were included. Interventions: Randomized clinical trials applying any dosage form of chlorhexidine were eligible. Main variables of interest: The relative risk (RR) of the VAP incidence and all-cause mortality was assessed using the random-effects model. The mean difference in days of mechanical ventilation duration and intensive care unit (ICU) length of stay were also appraised. Results: Ten studies involving 1233 patients were included in the meta-analysis. The oral application of CHX reduced the incidence of VAP (RR, 0.73 [95% CI, 0.55, 0.97]) and did not show an increase in all-cause mortality (RR, 1.13 [95% CI, 0.96, 1.32]). Conclusions: CHX proved effective to prevent VAP. However, a conclusion on mortality rates could not be drawn because the quality of the evidence was very low for this outcome.