Efficacy of Chlorhexidine in Preventing Ventilator-Associated Pneumonia: A Systematic Review of Randomized Controlled Trials

Abstract

Ventilator-associated pneumonia (VAP) is a common complication in intensive care units (ICUs) that leads to increased
morbidity, mortality, and healthcare costs. Chlorhexidine (CHX), a broad-spectrum antiseptic, is widely used for oral
care in intubated patients to prevent the development of VAP. This systematic review aimed to evaluate the efficacy
of CHX in preventing VAP in adult patients in the ICU. A comprehensive search was conducted in PubMed for
randomized controlled trials (RCTs) published between January 1, 2018, and October 30, 2024. Five RCTs met the
inclusion criteria and were included in this review. The primary outcomes were overall mortality and VAP episodes, and
the secondary outcomes were ICU stay duration and mechanical ventilation time. The results showed that CHX did not
significantly reduce mortality rates, VAP incidence, ICU stay duration, or mechanical ventilation time compared to the
control group. However, the risk of bias assessment revealed significant variability in the study quality, with concerns
about selection, performance, and detection biases. Despite the lack of significant impact on the outcomes assessed,
CHX may offer additional benefits in the ICU setting, such as reducing catheter-related bloodstream infections and
improving oral health. The decision to use CHX should be based on a comprehensive assessment of its benefits and
risks, considering patient characteristics and clinical settings. Further high-quality RCTs are needed to establish the
effectiveness of CHX in preventing VAP and improving patient outcomes in the ICU setting.