Effect of Oral Care with Povidone-Iodine in the Prevention of Ventilator-Associated Pneumonia; a Systematic Review and Meta-Analysis.

IF 2.9 Q1 EMERGENCY MEDICINE Archives of Academic Emergency Medicine Pub Date : 2023-01-01 DOI:10.22037/aaem.v11i1.1874
Amir Emami Zeydi, Arman Parvizi, Soudabeh Haddadi, Samad Karkhah, Seyed Javad Hosseini, Amirabbas Mollaei, Mahbobeh Firooz, Shahin Ramezani, Joseph Osuji, Pooyan Ghorbani Vajargah, Shadi Dehghanzadeh
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Abstract

Introduction: Ventilator-associated pneumonia (VAP) is one of the most common nosocomial infections affecting one-third of patients with mechanical ventilation. This study aimed to synthesize available evidence regarding the effect of treatment with povidone-iodine (PI) among adult patients admitted to intensive care units (ICUs) for the prevention of VAP.

Methods: An extensive search was conducted in online databases, including PubMed, Web of Science and Scopus, from the earliest records until January 1, 2023. STATA software v14 was used for statistical analysis. Publication bias was assessed via funnel plot, Begg's and Egger's tests. A P-value less than 0.1 was considered statistically significant for publication bias value.

Results: Four studies were included in the meta-analysis. Three studies showed rhat PI decreased VAP compared to the placebo group, but it was not statistically significant (RR: 0.61, 95%CI: 0.25 to 1.47, Z=1.10, P=0.27, I2:71.5%). One study compared the effect of PI with chlorhexidine on the rate of VAP, the difference between which was not statistically significant (RR: 1.50, 95%CI: 0.46 to 4.87, Z=0.67, P=0.50, I2:0). Two studies demonstrated that the use of PI intervention compared to placebo decreased the average length of stay in ICU; however, it was not statistically significant (WMD: -0.35, 95%CI:-3.90 to 3.20, Z=0.19, P=0.85, I2:0). Also, three studies showed that using PI had almost no effect on mortality rate compared to placebo (RR: 1.05, 95%CI: 0.66 to 1.53, Z=0.8, P=0.27, I2:29.0%).

Conclusion: More rigorously designed randomized clinical trials and further evidence are required to make a better decision/comparison about using PI as a suitable choice for preventing VAP among adult patients admitted to the ICU.

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聚维酮碘口腔护理对呼吸机相关性肺炎的预防作用系统评价和荟萃分析。
简介:呼吸机相关性肺炎(VAP)是最常见的医院感染之一,影响三分之一的机械通气患者。本研究旨在综合有关重症监护病房(icu)成年患者使用聚维酮碘(PI)治疗预防VAP的效果的现有证据。方法:广泛检索PubMed、Web of Science、Scopus等在线数据库,从最早记录到2023年1月1日。采用STATA软件v14进行统计分析。通过漏斗图、Begg’s和Egger’s检验评估发表偏倚。p值小于0.1认为发表偏倚值具有统计学意义。结果:meta分析纳入了4项研究。三项研究显示,与安慰剂组相比,rpi降低了VAP,但无统计学意义(RR: 0.61, 95%CI: 0.25 ~ 1.47, Z=1.10, P=0.27, I2:71.5%)。一项研究比较PI与氯己定对VAP率的影响,两组比较差异无统计学意义(RR: 1.50, 95%CI: 0.46 ~ 4.87, Z=0.67, P=0.50, I2:0)。两项研究表明,与安慰剂相比,使用PI干预可缩短ICU的平均住院时间;但差异无统计学意义(WMD: -0.35, 95%CI:-3.90 ~ 3.20, Z=0.19, P=0.85, I2:0)。此外,三项研究表明,与安慰剂相比,使用PI对死亡率几乎没有影响(RR: 1.05, 95%CI: 0.66至1.53,Z=0.8, P=0.27, i2:29 0%)。结论:需要更严格设计的随机临床试验和进一步的证据来更好地决定/比较在ICU成年患者中使用PI作为预防VAP的合适选择。
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来源期刊
Archives of Academic Emergency Medicine
Archives of Academic Emergency Medicine Medicine-Emergency Medicine
CiteScore
8.90
自引率
7.40%
发文量
0
审稿时长
6 weeks
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