EFFECTIVENESS OF CHLOREXIDINE DIGLUCONATE CONCENTRATIONS IN REDUCING THE INCIDENCE OF VAP IN PATIENTS ADMITTED TO THE ICU: a critical review of the literature (Atena Editora)

Abstract

The objective of this review was to identify and critically analyze the evidence in the scientific literature, through clinical trials, to compare the effectiveness of various concentrations of chlorhexidine with the same solution and the one most frequently used in the oral hygiene of hospitalized patients. The authors carried out an electronic and manual search in several databases (Pubmed, Scielo, Lilacs, Cochrane) and gray literature (Theses Bank and Google Scholar). There were no limitations regarding the year of publication or language. A total of 176 articles were selected and systematically analyzed according to the inclusion criteria that were pre-defined (clinical trials, randomized or not, in any language, conducted on sick patients, regardless of sex, age, race, admitted to hospitals, whether in the ICU or in other sectors). These articles were evaluated, the data considered relevant were extracted and a classification was made according to the quality of the methodological evidence found, with level I if it met all criteria or four (with only one B). Level II if partially met the criteria (maximum two C assessments). Level III if it followed two criteria or less (more than two Cs). The only study selected was classified as evidence level III, as it did not include the necessary information for a good quality study and, therefore, was considered to have a high risk of bias. Regarding the treatment used, the chlorhexidine solution was compared to the same product at a different concentration in the control group. Given the great variability of concentrations of this mouthwash, more research must be carried out so that there is greater certainty and standardization of which concentration proves to be most effective in preventing aspiration pneumonia in hospitalized patients.