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Table 1 Main characteristics of randomized controlled trials included in the meta-analysis of toothbrushing for ventilator-associated pneumonia prevention

From: Impact of oral care with versus without toothbrushing on the prevention of ventilator-associated pneumonia: a systematic review and meta-analysis of randomized controlled trials

Author/Year Number of patients (I/C) Type of ICU/Study population Severity of illness (I/C) Intervention group Control group Definition of VAP Study design/Jadad score Funding
bias
Length of follow-up, days Rate of successful follow-up
Munro et al. [20] (2009) 192 (97/95) Medical-surgical/adult patients requiring MV > 24 hours, with no current pneumonia APACHE III score: 76.4 ± 23.3/76.2 ± 3.3 and 76.2 ± 25.5/80.4 ± 28.7 0.12% CHX and toothbrushing (that is, soft pediatric toothbrush and toothpaste; brushing tooth by tooth, on anterior and posterior surfaces, the palate, and the tongue) 0.12% CHX 5 mL by oral swab twice
daily or usual care
CPIS > 6 Non-blind, RCT/2 No 3 46%
Pobo et al. [21] (2009) 147 (74/73) Surgical/adult patients requiring MV > 48 hours, with no current pneumonia APACHE II score: 18.8 ± 7.1/18.7 ± 7.3 0.12% CHX and toothbrushing every 8 hours (that is, electric toothbrush; brushing tooth by tooth, on anterior and posterior surfaces, the gum line, and the tongue) Oral care every 8 hours with 0.12% CHX New or progressive pulmonary opacities together with purulent respiratory secretions plus fever > 38°C or leukocytosis > 10,000 cells/mL Single-blind, RCT/3 No 28 100%
Yao et al. [22] (2011) 53 (28/25) Medical-surgical/adult patients requiring MV > 48 to 72 hours, with no current pneumonia APACHE II score: 19.6 ± 5.2/19.4 ± 4.4 Usual care using cotton swabs, elevating the head of the bed, moisturizing the lips, and before-and-after hypopharyngeal suctioning; toothbrushing (that is, electric and soft pediatric toothbrush; brushing tooth with purified water, teeth facial sides cleansed with electric toothbrush, and lingual sides, gums, mucosa, and tongue cleansed with pediatric toothbrush) Usual care using cotton swabs, elevating the head of the bed, moisturizing the lips, and before-and-after hypopharyngeal suctioning CPIS > 6 Single-blind, pilot, RCT/3 No 9 68%
Lorente et al. [23] (2012) 436 (217/219) Medical, surgical/trauma, and neuroscience/adult patients requiring MV > 24 hours, with no current pneumonia APACHE II score: 17.88 ± 8.84/19.16 ± 9.88 0.12% CHX and toothbrushing (that is, manually brushing tooth by tooth, on the anterior and posterior surfaces, the gum line, and the tongue for a period of 90 seconds) Oral cleansing every 8 hours with 0.12% CHX New onset of bronchial purulent sputum; body temperature > 38°C or < 35.5°C; white blood cell count > 10,000/mm3 or < 4,000/mm3; chest radiograph showing new or progressive infiltrates; significant quantitative culture of respiratory secretions by tracheal aspirate (> 106 CFU/mL) Single-blind, RCT/3 No Not reported 100%
  1. APACHE, Acute Physiology and Chronic Health Evaluation; CFU, colony-forming units; CHX, chlorhexidine; CPIS, clinical pulmonary infection score; I/C, intervention/control; ICU, intensive care unit; MV, mechanical ventilation; RCT, randomized controlled trial; VAP, ventilator-associated pneumonia.