Oral care interventions in adult intensive care unit patients: A systematic review of oral and respiratory outcomes.

BACKGROUND

Adult intensive care unit (ICU) patients, especially those receiving mechanical ventilation, are prone to rapid oral and mucosal deterioration, which may contribute to respiratory infection. Oral care protocols vary widely and their effects on clinically important outcomes remain uncertain.

OBJECTIVES

To synthesize evidence regarding oral care interventions in adult intensive care patients across oral, microbiological, respiratory, and major clinical outcomes, including feasibility and safety when reported.

METHODS

PubMed, Scopus, Web of Science, and LILACS were searched from inception to February 1, 2025. Full-text English-language primary studies that evaluated oral care interventions in adult ICU patients were included, whereas non-ICU, pediatric, non-interventional, non-primary, and non-English studies were excluded. Risk of bias was assessed using RoB 2 and ROBINS-I. Due to heterogeneous designs, interventions, and outcomes, findings were narratively synthesized by outcome domain.

RESULTS

Twenty-three studies were included. Most protocolized interventions, which usually combined mechanical plaque removal, antiseptic cleansing, suction, and moisturization, improved oral and mucosal outcomes, with benefits most evident after 48-72 h. Microbiological effects were generally transient, with rapid recolonization. Respiratory findings were inconsistent, where some studies reported lower incidences of ventilator-associated pneumonia or diagnostic scores with alternative mouthwashes or higher-concentration chlorhexidine, whereas others found no benefit for mortality or major respiratory outcomes, including a large bundle-based trial. Certainty was limited by heterogeneity, short follow-up, variable study quality, and lack of quantitative pooling.

CONCLUSIONS

Protocolized multimodal oral care appears to improve oral and mucosal health in adult ICU patients, but consistent effects on ventilator-associated pneumonia and major clinical outcomes still need to be demonstrated. Standardized bundles and higher-quality pragmatic trials are required.