SYSTEMATIC REVIEW

A Systematic Review

Oral Chlorhexidine in the prevention of ventilator associated pneumonia in critically ill adults in the ICU: A systematic review

Background

Between nine percent and twenty percent of individuals who are ventilated mechanically develop VAP (ATSIDSA, 2005). Rates of death for patients who improve Ventilator associated pneumonia are high, with thirty three to fifty percent of ventilated patients dying (Augustyn, 2007). No statistical information on nosocomial pneumonia or nosocomial infections relevant to the developing countries was discovered in a noteworthy literature search. Chlorhexidine is categorized as a cationic antiseptic agent. It is utilized as an oral disinfectant within the patients that are individuals that are ventilated mechanically in view of its ability to tie to oral tissues with ensuing moderate release of antiseptic characteristics and in this manner a long time of antibacterial action (Powers, 2006). Studies keeping focus on oral care in the patients that are critically ill, particularly with the simultaneous utilization of chlorhexidine, have not given enough proof of Ventilator associated pneumonia prevention.

Aim of the Study

The basic objective of this research is to review systematically as well as assess evidence on the viability of chlorhexidine as an oral disinfectant to decrease the rate of Ventilator associated pneumonia (VAP) in individuals that are ventilated mechanically versus a placebo or control. The viability of chlorhexidine will be resolved in the joined research studies when utilized with different comparators including bicarbonate isotonic rinse, rinse by normal saline, listerine, placebos, serum rinse as well as tooth brushing. The secondary purpose is to sum up evidence on the utilization of chlorhexidine in lessening death rate.

Research Question

Is oral chlorhexidine effective in the VAP ventilator-associated pneumonia prevention in mechanically ventilated, critically ill adult patients in Intensive care units?

Literature Review

Portrayal of the condition Ventilator associated pneumonia can occur in individuals that are critically ill and who are ventilated mechanically for more than forty eight hours (Munro & Grap, 2004, pp. 25-34). Pathogenesis incorporates the microorganisms passage to the LRT of patients and overpowering of the defences of patient (Fourrier, et al., 2005, pp. 1728-1735). Ventilator associated pneumonia could be recognized when a radiograph of chest shows an alternate infiltrate, pleural effusions, consolidations and the person has no not exactly one of the accompanying implications: new purulent sputum onset or a change in sputum colour, raised temperature, improved or decreased count of white blood cells, organisms that are cultured from blood, and extraction of an aetiological executor by bronchial brushing, transtracheal biopsy or aspirate. In intensive care units, mechanical ventilation is used as backing treatment within one-third of people (O'reilly, 2003, pp. 101-110; Morton,et al., 2005).

Sequential examining of dental plaque from the patients of Intensive Care Unit showed that majority of the patient who has obtain a respiratory infection have been colonised before by the same microorganism at the gingivodental level (Scannapieco, et al., 2009). Teeth ought to be affirmed a considerable for respiratory pathogens store, and cleaning of oropharynx with sterile solutions can diminish the rate of acquired respiratory infections (Wagh, 2009, ...