surgery is an elective procedure. As such, cardiosurgical
patients are usually in better physical condition than are
general patients in intensive-care units. Those requiring
valve surgery are moreover submitted to a thorough
preoperative dental and oral control, and to tooth
extraction if required. Also, cardiosurgical patients are
intubated in the operating theatre under optimum and
controlled conditions, whereas critically ill patients are
more often emergently intubated, in less optimum
circumstances. Considering all the above, it is not
surprising that the benefi cial eff ects from oral care on
occurrence of ventilator-associated pneumonia in
cardiosurgical patients (RR 0·41) largely exceed those in
mixed intensive-care-unit patients (RR 0·77). Finally,
cardiosurgical patients generally have less confounders
and experience a shorter period of mechanical ventilation
than do medical or trauma patients. Thereby, oral
antiseptics could be assumed to be more successful in
the prevention of early onset compared with late onset
ventilator-associated pneumonia, occurring 5 days or
more after endotracheal intubation. Due to a lack of
available data, however, the present review remains
inconclusive on this issue.