Oral Health, Ventilator-Associated Pneumonia, and Intracranial Pressure in Intubated Patients in a Neuroscience Intensive Care Unit

Abstract

Background Although oral health affects systemic health, studies of oral health during intubation among critically ill neuroscience patients are lacking. Furthermore, the effect of oral care on intracranial pressure among critically ill patients in a neuroscience intensive care unit is unknown. Objectives To describe changes in oral health and development of ventilatorassociated pneumonia during intubation among patients in a neuroscience intensive care unit and to assess the influence of oral care on intracranial pressure. Methods Data on 45 consecutive intubated patients admitted to a neuroscience intensive care unit during 1 year were collected by using oral cultures and the Oral Assessment Guide throughout intubation and 48 hours after extubation. Occurrence of ventilator-associated pneumonia and intracranial pressures associated with oral care were recorded. Results Oral health, assessed by the Oral Assessment Guide, deteriorated significantly during intubation and improved to almost baseline levels 48 hours after extubation. During intubation, occurrence of oral gram-negative bacteria and yeast increased. The incidence of ventilator-associated pneumonia was 24% among patients enrolled for 4 to 10 days. During or after 879 instances of oral care, overall intracranial pressure did not increase. Among 30 instances in which intracranial pressure was greater than 20 mm Hg before oral care, pressure decreased during and 30 minutes after the procedure (P < .001). Conclusions Intubation may contribute to worsening of oral health among patients in neuroscience intensive care units. Execution of oral care does not seem to affect intracranial pressure adversely. Oral care should be explored further to promote good oral and systemic health in patients in neuroscience intensive care units and to determine its effect on ventilator-associated pneumonia.

Effects of Chlorhexidine Solution Formula on Oral Health Status and Occurrence of Ventilator -Associated Pneumonia among Intubated Intensive Care Unit Patients

“…So, it can be said that oral care with use of chlorhexidine solution formula was the best solution that improve oral health status. This finding supported by Prendergast et al, (2009) (35) who found that during intubation, total oral assessment grade scores increased from baseline to 12 th day. Regarding to modified clinical pulmonary infection sheet score (CPIS), the current study for body temperature, observed that there was no significant difference observed among patients in study and control groups on the first, second, third, fourth and fifth day.…”

Effects of Nursing Interventions on Intracranial Pressure

“…[8][9][10][11][12][13][14][15][16][17] In contrast, administration of oral care by using either manual or electric toothbrushes among intubated neurologically impaired patients does not result in significant increases in ICP. 18,19 Similarly, Olson et al, in a series of 3 articles, 5,20,21 explored the effects of chest percussion therapy on ICP, finding that such therapy does not adversely affect ICP and may be associated with lower ICP for some patients. Although these interventions are often necessary to provide adequate care for critically ill patients, as they reduce risk of ventilatorassociated pneumonia and pressure ulcers, other nursing interventions are performed with the aim of specifically decreasing ICP values.…”

Qualidade de saúde bucal e pneumonia associada à ventilação mecânica

“…alteração bioquímica da superfície bucal do paciente, aumentando a adesão e consequentemente sua colonização por patógenos respiratórios 14,15 . Um estudo realizado por Oliveira et al 16 descreve uma amostra de 30 pacientes em que foram encontrados 70% de patógenos respiratórios no biofilme dental, 63,33% no dorso da língua e 73,33% no filtro do respirador artificial, corroborando com a literatura sobre tudo na necessidade de uma maior investigação que aponte o perfil microbiológico da cavidade bucal dos pacientes admitidos no CTI, em decorrência de uma incidência significativa de suporte ventilatório através de intubação orotraqueal e traqueostomia em 84% (n=31) e de um expressivo número de pacientes com comprometimento na integridade da cavidade bucal.…”