Oral Care in Critically Ill Patients Requiring Noninvasive Ventilation: An Evidence-Based Review

Johnny, Jace D.; Drury, Zachary; Ly, Tracey; Scholine, Janel

doi:10.4037/ccn2021330

Cited by 3 publications

(4 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…10 However, the relationship between oral hygiene and the reduction of oropharyngeal colonization with pathogenic organisms is rarely recognized. 11 Previous systematic reviews recommend oral cavity disinfection with chlorhexidine for patients at risk of VAP. 11,12 These reviews overlooked the type of microorganisms and their drug resistance.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Oropharyngeal Decontamination for Prevention of VAP in PatientsAdmitted to Intensive Care Units: A Systematic Review

Keykha

Ramezani²,

Amini

et al. 2021

J Caring Sci

View full text Add to dashboard Cite

Introduction: Oropharyngeal colonization with pathogenic organisms contributes to thedevelopment of ventilator-associated pneumonia (VAP) in intensive care units (ICUs). Oralhygiene care (OHC) is a very effective method for reducing the risk of VAP in these patients.This study aimed to evaluate recent OHC strategies to decrease VAP.Methods: Randomized clinical trials (RCTs) published in the PubMed, Scopus, Embase,Cochrane Library, and Web of Science databases from inception to September 10, 2020 werereviewed to compare the effects of selective oropharyngeal decontamination (SOD) on theincidence of VAP in adult patients requiring mechanical ventilation.Results: Out of a total of 1098 articles reviewed, 17 eligible studies were included for finalanalysis. The results showed that the use of chlorhexidine for oropharyngeal decontaminationreduces the incidence of VAP. However, it had a small effect on gram-negative resistant bacteria.Also, it was observed that the combined use of colistin and chlorhexidine was more effectivethan chlorhexidine alone in preventing VAP. The results of studies on the use of toothbrushes toreduce the incidence of pneumonia are unclear since they used chlorhexidine at the same time.However, tooth brushing is one of the best ways to maintain oral hygiene. Using povidoneiodine,Nanosil, and non-absorbable topical antibiotics reduced the incidence of VAP, whileIseganan did not show a significant effect in this regard.Conclusion: The prophylactic use of topical bactericidal agents in critically-ill patients is effectivein reducing the incidence of VAP. However, the use of non-absorbable topical antibiotics ismore effective than other methods in oropharyngeal decontamination.

show abstract

Section: Introductionmentioning

confidence: 99%

“…11 Previous systematic reviews recommend oral cavity disinfection with chlorhexidine for patients at risk of VAP. 11,12 These reviews overlooked the type of microorganisms and their drug resistance. Aerobic gram-negative bacteria are the most common cause of VAP microorganisms in the ICU.…”

Section: Introductionmentioning

confidence: 99%

Oropharyngeal Decontamination for Prevention of VAP in PatientsAdmitted to Intensive Care Units: A Systematic Review

Keykha

Ramezani²,

Amini

et al. 2021

J Caring Sci

View full text Add to dashboard Cite

show abstract

“…SAP in dysphagia is most often caused by aspiration. In order to prevent aspiration pneumonia, it is important to assess the degree of swallowing and intervene early during hospitalization [3,43], and oral care is vital given that aspiration pneumonia is also caused by oropharyngeal colonization [44]. However, there is still a lack of awareness, knowledge, and skills in oral care among personnel caring for people with dysphagia.…”

Section: Discussionmentioning

confidence: 99%

“…However, there is still a lack of awareness, knowledge, and skills in oral care among personnel caring for people with dysphagia. Therefore, there is a need to improve the quality of oral care through education and the implementation of oral hygiene protocols [44].…”

Section: Discussionmentioning

confidence: 99%

A Simple Nomogram for Predicting Stroke-Associated Pneumonia in Patients with Acute Ischemic Stroke

Lee,

Jang

2023

Healthcare

View full text Add to dashboard Cite

The purpose of this study was to develop a prediction model for stroke-associated pneumonia (SAP) based on risk factors for SAP and to suggest nursing interventions to prevent SAP. In addition, a nomogram was developed to enhance its utility in nursing practice. The retrospective cohort study included 551 patients hospitalized for acute ischemic stroke at a university hospital in South Korea. Data were collected through a structured questionnaire and a review of the electronic medical record (EMR). In the development of a predictive model for SAP, multivariate logistic regression analysis showed that independent risk factors for SAP were age ≥ 65 years, National Institute of Health Stroke Scale (NIHSS) score ≥ 7, nasogastric tube feeding, and C-reactive protein (CRP) ≥ 5.0 mg/dL. The logit model was used to construct the SAP prediction nomogram, and the area under the curve (AUC) of the nomogram was 0.94. Furthermore, the slope of the calibration plot was close to the 45-degree line, indicating that the developed nomogram may be useful for predicting SAP. It is necessary to monitor the age, NIHSS score, nasogastric tube feeding status, and CRP level of stroke patients and identify high-risk groups using the developed nomogram to provide active nursing interventions to prevent SAP.

show abstract

Routine (7 days) vs. clinically indicated change of the noninvasive ventilator circuit for prevention of hospital-acquired pneumonia: Protocol for a randomized controlled trial in 2 tertiary hospitals

Zhang

Zhu

Wang

et al. 2022

Preprint

View full text Add to dashboard Cite

Background The change frequency of the ventilator circuit was once thought to be the main cause of ventilator-associated pneumonia (VAP), but recent evidence has shown that it is not strongly relevant to VAP in invasively ventilated patients. However, circuits of noninvasive positive pressure ventilation (NPPV) are still routinely (every 7 days) changed in many hospitals to prevent hospital-acquired pneumonia (HAP) without evidence, which is a heavy economic burden on the health system. Methods This is a nonblinded, prospective, randomized controlled multicenter trial. Patients who receive NPPV onset in this hospitalization will be screened for eligibility. A total of 340 eligible participants will be stratified (3:2) in two research sites and will be randomly allocated to routine changes in the ventilator circuit group or clinically indicated changes in the circuit group at a ratio of 1:1. Routine prevention for HAP will be provided in both groups. The primary outcome is the occurrence of HAP 48 hrs after NPPV therapy starts or 48 hrs within weaning from NPPV. Secondary outcomes include the length of hospital stay, length of each circuit duration, NPPV treatment days, intubation, mortality and direct cost of the circuits and antibiotics. The growth curve of microorganisms in the ventilator circuit will also be analyzed. It is hypothesized that there will be no difference in the occurrence of HAP in the two arms. Furthermore, a decrease in circuit cost is expected in the intervention group, and the microorganisms in the ventilator circuit are predicted to not increase over time. Discussion NPPVs are widely used in patients with various diseases from different healthcare settings. Evidence-based rules for changing NPPV circuits are limited. If supported, our pioneer study will provide a cost-effective NPPV management method without increasing the risks of HAP.

show abstract

Oral Care in Critically Ill Patients Requiring Noninvasive Ventilation: An Evidence-Based Review

Cited by 3 publications

References 21 publications

Oropharyngeal Decontamination for Prevention of VAP in PatientsAdmitted to Intensive Care Units: A Systematic Review

Oropharyngeal Decontamination for Prevention of VAP in PatientsAdmitted to Intensive Care Units: A Systematic Review

A Simple Nomogram for Predicting Stroke-Associated Pneumonia in Patients with Acute Ischemic Stroke

Routine (7 days) vs. clinically indicated change of the noninvasive ventilator circuit for prevention of hospital-acquired pneumonia: Protocol for a randomized controlled trial in 2 tertiary hospitals

Contact Info

Product

Resources

About