Effect of different mouthwashes on ventilator-related outcomes and mortality in intensive care unit patients: A network meta-analysis

source extracted confidence: high 2026-04-09
#humans #hospital-mortality #intensive-care-units #mouthwashes #oral-hygiene

Effect of different mouthwashes on ventilator-related outcomes and mortality in intensive care unit patients: A network meta-analysis

He et al., 2025 | Aust Crit Care | Systematic Review

Citation

He Qianqian, Peng Zengjin, ... Hu Rong. Effect of different mouthwashes on ventilator-related outcomes and mortality in intensive care unit patients: A network meta-analysis. Aust Crit Care. 2025-Jan;38(1):101095. doi:10.1016/j.aucc.2024.06.014

Abstract

BACKGROUND: Ventilator-associated pneumonia is a common and life-threatening complication in intensive care unit (ICU) patients. Maintaining oral hygiene is crucial for reducing ventilator-associated pneumonia incidence. Various mouthwash solutions are used for oral care in ICU settings, but their comparative effectiveness remains unclear. This study aims to systematically evaluate and compare the efficacy and safety of commonly used mouthwashes for oral care in mechanically ventilated ICU patients. METHODS: We searched PubMed, Web of Science, Embase, and Cochrane Library for randomised controlled trials (RCTs) comparing saline, chlorhexidine, sodium bicarbonate, oxidising agents, herbal extracts, and povidone-iodine for oral care in ventilated ICU patients. Outcomes included ventilator-associated pneumonia incidence, ICU mortality, duration of ventilation, and Escherichia coli fixed value. A network meta-analysis (NMA) was conducted to synthesise direct and indirect evidence. This study is registered with the International Platform of Registered Systematic Review and Meta-analysis Protocols, 2023120028. RESULTS: FourteenRCTs with 1644 participants were included. Oxidising agents showed a trend towards reducing the incidence of VAP compared to the control group (risk ratio: 0.24, 95% confidence interval: 0.05-1.10). Administration of saline was associated with a notable reduction in ICU mortality (risk ratio: 0.18, 95% confidence interval: 0.04-0.88) versus no mouthwash. No significant differences were observed in the duration of mechanical ventilation between chlorhexidine, povidone-iodine, and the control group. CONCLUSIONS: Antimicrobial mouthwashes, especially chlorhexidine, pose potential risks in ICU patients; oxidising solutions demonstrate relative safety. Saline solution emerges as a promising alternative, associated with a significant reduction in mortality rates. However, the need for large, high-quality RCTs remains paramount to substantiate these findings and establish evidence-based oral-care protocols in ICU settings. REGISTRATION: This study is registered with the International Platform of Registered Systematic Review and Meta-analysis Protocols, 2023120028.

Key Findings

FourteenRCTs with 1644 participants were included. Oxidising agents showed a trend towards reducing the incidence of VAP compared to the control group (risk ratio: 0.24, 95% confidence interval: 0.05-1.10). Administration of saline was associated with a notable reduction in ICU mortality (risk ratio: 0.18, 95% confidence interval: 0.04-0.88) versus no mouthwash. No significant differences were observed in the duration of mechanical ventilation between chlorhexidine, povidone-iodine, and the cont

Outcomes Measured

  • Requires manual extraction

Population

Field Value
Population See abstract
Sample Size 1644
Age Range See abstract
Condition See abstract

MeSH Terms

  • Humans
  • Hospital Mortality
  • Intensive Care Units
  • Mouthwashes
  • Oral Hygiene
  • Pneumonia, Ventilator-Associated
  • Respiration, Artificial

Evidence Classification

  • Level: Systematic Review
  • Publication Types: Journal Article, Network Meta-Analysis, Systematic Review
  • Vertical: iodine

Provenance

Source extracted via PubMed E-utilities API on 2026-04-09