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

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 oftreatment with povidone-iodine (PI) among adult patients admitted to intensive care units (ICUs) for the prevention ofVAP.

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 biaswas assessed via funnel plot, Begg’s and Egger’s tests. A P-value less than 0.1 was considered statistically significant forpublication bias value.

Four studies were included in the meta-analysis. Three studies showed rhat PI decreasedVAP 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 whichwas 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 theuse of PI intervention compared to placebo decreased the average length of stay in ICU; however, it was not statisticallysignificant (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 noeffect 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%).

Morerigorously designed randomized clinical trials and further evidence are required to make a better decision/comparisonabout using PI as a suitable choice for preventing VAP among adult patients admitted to the ICU.