Commentary: Munro CL et al. (2006). Oral health status and development of ventilator‐associated pneumonia: a descriptive study

Abstract

AbstractBackground: Ventilator‐associated pneumonia (VAP) is a significant cause of morbidity and mortality and may be influenced by oral health.Objective: To describe the relationship between VAP and oral health status, changes in oral health status during the first 7 days after intubation and microbial colonization of the oropharynx and trachea.Methods: A total of 66 patients were enrolled within 24 h of intubation and were followed up for up to 7 days. Data on oral health measures and the clinical pulmonary infection score (CPIS) were collected at baseline, day 4 (n = 37) and day 7 (n = 21). A regression model was used to predict risk of pneumonia at day 4.Results: Dental plaque and oral organisms increased over time. Correlations were significant for baseline and day 4 dental plaque (P < 0·001), baseline salivary lactoferrin and day 4 plaque (P = 0·01), and lower salivary volume and higher day 4 CPIS (P = 0·02). Potential pathogens were identified in oral cultures for six patients before or at the same time as the appearance of the organisms in tracheal aspirates. Correlations were significant with day 4 CPIS for score on the Acute Physiology and Chronic Health Evaluation (APACHE) II (P = 0·007), day 4 salivary volume (P = 0·02), interaction of APACHE II score and day 1 CPIS (P < 0·001), and interaction of day 1 CPIS and plaque (P = 0·01).Conclusions: Higher dental plaque scores confer greater risk for VAP, particularly for patients with greater severity of illness. Salivary volume and lactoferrin may affect the risk. Abstract reprinted from American Journal of Critical Care, volume 15, Munro CL et al., ‘Oral health status and development of ventilator‐associated pneumonia: a descriptive study.’, pages 453–460. © 2006, reproduced with permission from American Association of Critical Care Nurses.