Abstract
The objective of the present study is toassess risk at the stage of proofs, including oral health status, with the development of VAP in perioperative patients, with the final aim of the establishing oral health management systems in acute care hospitals. Of the patients who were admitted to the Intensive Care Unit (ICU) of our university hospital from January to December 2011 and who underwent oral intubation, 11 patients who received a diagnosis of VAP (nine men and two women) and 11 control patients (eight men and three women) were selected as subjects for the present study. We first investigated the disease names listed in the medical records of subjects in the VAP group and then selected patients who had the same diseases as the control group subjects. Within one day after admission to the ICU, a dentist evaluated the oral health status of the patients and the lips, teeth, oral mucosa, gingiva, tongue and xerostomia were scored (0-12) based on the criteria of the Revised Oral Assessment Guide (ROAG). Furthermore, six items (operative duration, BMI, length of ICU stay, Acute Physiology and Chronic Health Evaluation (APACHE II) score and length of ventilator used) were extracted from patient medical records and investigated. The items were used as independent variables and their relationship with the development of VAP was examined by regression analysis. Oral health care was performed by a nurse four times per day, using a standard toothbrush or sponge brush. Moreover, this study was approved by the Ethics Committee of the Department of Dentistry in our university. When each factor was compared in the VAP group and the control group, the VAP group showed significantly higher scores for oral health status, length of ICU stay and length of ventilator used. Furthermore, when the development of VAP and the relationships with each factor were examined by regression analysis, a significant relationship with oral health status, operative duration, BMI and length of ventilator use was seen. The results of the present study suggest the possibility of various factors being involved in the development of VAP in orally intubated patients, such as the oral health status of the patient. Appropriate oral health care can aid the prevention of perioperative pulmonary infections.
Highlights
Oral care has been shown to be effective in the prevention of pulmonary infections, including aspiration pneumonia (Segers et al, 2008; Of these cases, because contamination of the oral cavity or pharynx in patients receiving artificial respiration can lead to Ventilator-Associated Pneumonia (VAP), a serious form of pneumonia, the importance of oral care during the acute phase has become widely known (Feider et al, 2010; Hutchins et al, 2009; Mori et al, 2006)
Of patients who were admitted to our university hospital from April 2010 to March 2012 and received artificial respiration via oral intubation, 17 patients who received a diagnosis of VAP (VAP group) and 17 patients in whom pneumonia did not develop were selected as subjects for the present study
The VAP development showed a significant relationship with operative duration, length of Intensive Care Unit (ICU) stay, length of ventilator use and Revised Oral Assessment Guide (ROAG) score
Summary
Oral care has been shown to be effective in the prevention of pulmonary infections, including aspiration pneumonia (Segers et al, 2008; Of these cases, because contamination of the oral cavity or pharynx in patients receiving artificial respiration can lead to Ventilator-Associated Pneumonia (VAP), a serious form of pneumonia, the importance of oral care during the acute phase has become widely known (Feider et al, 2010; Hutchins et al, 2009; Mori et al, 2006). Because perioperative artificial respiration is a commonly performed procedure, prevention of VAP is a major issue for the general care of patients. Risk factors such as patient bed positioning, level of sedation and gastroesophageal reflux are thought to increase the risk of development of VAP, indicating that many factors are involved (Parker et al, 2008; Akça et al, 2000). For this reason, various bundles are used as prophylaxis and general care and management of oral hygiene are performed (Rello et al, 2010). Because multiple factors are involved in the development of VAP, no gold standard for prophylactic treatment has been established
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