Effects of different oral care scrubs on ventilatorassociated pneumonia prevention for machinery ventilates patient: A protocol for systematic review, evidence mapping, and network meta-analysis

Abstract

Background: Ventilator-associated pneumonia (VAP) is defined as pneumonia develops in intensive care unit (ICU) patients who have been mechanically ventilated for at least 48hours. Implementing effective oral car could reduce the incidence of VAP. However, previous studies on scrubs in oral care have failed to suggest which the best choice. Therefore, this protocol proposes to perform a network meta-analysis to evaluate the effectiveness of different oral care scrubs in preventing VAP. Methods: We are going to search the electronic databases: Cochrane Oral Health's Trials Register, CENTRAL, MEDLINE, EMBASE, CINAHL, and Chinese Biomedical Literature Database. Study selection and data collection will be performed independently by 2 reviewers. Cochrane Risk of Bias tool will be used to assess the risk of bias of included studies. Odds ratio (OR) and 95% confidence intervals (CIs) will be used to assess the incidence rate of VAP in critical patients. The evidence mapping (EM) method will be introduce as a tool intended to complement the conventional systematic review (SR) and is suitable for this issue, at the same time, R software will be used for representing the outcome of EM-SR. We shall assess the heterogeneity on the bias of the magnitude of heterogeneity variance parameter (I2 or Cochrane Q). We are also going to conduct subgroup analysis and sensitivity analysis if needed. The application of Stata and R software will be performed the calculations. Results: The results of this study will be submitted to a peer-reviewed journal for publication. Conclusion: This network meta-analysis will provide comprehensive evidence of different scrubs in oral care for preventing VAP. PROSPERO registration number: CRD42018117019. Abbreviations: AACN = American Association of Critical-Care Nurses, CENTRAL = Cochrane Central Register of Controlled Trials, CINAHL = Cumulative Index to Nursing and Allied Health Literature, CIs = confidence intervals, EM = evidence mapping, GRADE = Grading of Recommendations Assessment, Development, and Evaluation, HAP = hospital-acquired pneumonia, ICP = intracranial pressure, IHI = Institute for Healthcare Improvement, INICC = International Nosocomial Infection Control Consortium, NMA = network meta-analysis, OR = odds ratio, PRISMA-P = Preferred Reporting Items for Systematic review and Meta-Analysis Protocols, PROSPERO = International Prospective Register of Systematic Reviews, RCTs = randomized controlled trials, SR = systematic review, VAP = ventilator-associated pneumonia.