Chlorhexidine-Related Mortality Rate in Critically Ill Subjects in Intensive Care Units: A Systematic Review and Meta-Analysis

Respir Care. 2019 Mar;64(3):337-349. doi: 10.4187/respcare.06434.


Background: This meta-analysis aimed to explore the chlorhexidine-related mortality rate for subjects on mechanical ventilation and in an ICU when compared with subjects who received standard ICU care.

Methods: We searched a number of medical literature databases and the first 100 results in an internet search. Two of us independently reviewed the titles and abstracts of the identified articles. Then general and specific characteristics from eligible articles were extracted and the quality of included trials were appraised by using a risk of bias assessment tool. Risk ratios were calculated, together with the 95% CI. Random-effects models with the Mantel-Haenszel method were used to estimate pooled probabilities. Heterogeneity was identified and quantified via the chi square test and I2 values, respectively.

Results: Eleven of the 547 studies were suitable for this meta-analysis. The included participants were critically ill adults in ICU settings of high-income countries (n = 1157) and low/ middle-income countries (n = 612). They were assigned to either the chlorhexidine or control groups. Overall, moderate-quality evidence indicated reduced ventilator-associated pneumonia incidence (for high-income countries: RR 0.60, 95% CI 0.41-0.87; P = .008; I2 = 39%; and for low- and middle-income countries: RR 0.71, 95% CI 0.51-0.99; P = .05; I2 = 10%), without a substantial effect on mortality rate (for high-income countries: RR 1.01, 95% CI 0.65-1.57; P = .96; I2 = 42%; and for low- and middle-income countries: RR 1.11, 95% CI 0.96-1.29; P = .17; I2 = 0%).

Conclusions: The prophylactic administration of chlorhexidine among patients who were critically ill and in an ICU setting reduced the occurrence of ventilator-associated pneumonia with no significant impact on associated mortality.

Keywords: chlorhexidine; evidence-based care; hospital mortality; intensive care unit; oral rinse; ventilator-associated pneumonia.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Chlorhexidine / administration & dosage*
  • Chlorhexidine / adverse effects
  • Critical Care / methods
  • Critical Illness / mortality
  • Critical Illness / therapy
  • Female
  • Hospital Mortality / trends*
  • Humans
  • Incidence
  • Intensive Care Units*
  • Male
  • Pneumonia, Ventilator-Associated / prevention & control*
  • Respiration, Artificial / adverse effects
  • Respiration, Artificial / methods
  • Risk Assessment


  • Chlorhexidine