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Oral Care in Intubated Patients: Necessities and Controversies

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Annual Update in Intensive Care and Emergency Medicine 2014

Part of the book series: Annual Update in Intensive Care and Emergency Medicine ((AUICEM,volume 2014))

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Abstract

Healthcare professionals in both the community and hospital settings are responsible for maintaining good oral health of patients who are not able to perform this simple activity themselves. Cancer patients receiving chemotherapy or radiotherapy, institutionalized elderly, and patients in a critical care environment (intensive care unit [ICU]) are undeniably among the most vulnerable patients, in whom oral status deserves adequate attention because they may suffer from poor oral health [1, 2].

Oral health deteriorates following admission to hospital, and in the critical care setting in particular [3]. Patients who are tracheally intubated and mechanically ventilated are most prone to bad oral health, as a result of various physiological, pathological, mechanical and immunological factors [2, 4, 5]. In addition to issues relating to patient comfort, a lack of oral hygiene is associated with increased morbidity [6, 7]. Poor oral health may lead to the development of caries, thus causing permanent damage to teeth. Potentially lethal complications, such as ventilator-associated pneumonia (VAP), may also be the result of inadequate oral care. The added costs of complications are exponentially higher than the expenses associated with thorough prevention so that complications due to inadequate oral hygiene may carry a substantial health-economic burden [8].

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References

  1. McNeill HE (2000) Biting back at poor oral hygiene. Intensive Crit Care Nurs 16:367–372

    Article  CAS  PubMed  Google Scholar 

  2. Scannapieco FA (2006) Pneumonia in nonambulatory patients: The role of oral bacteria and oral hygiene. J Am Dent Assoc 137:21S–25S

    Article  PubMed  Google Scholar 

  3. Terezakis E, Needleman I, Kumar N, Moles D, Agudo E (2011) The impact of hospitalization on oral health: a systematic review. J Clin Periodontol 38:628–636

    Article  PubMed  Google Scholar 

  4. Grap MJ, Munro CL, Elswick RK, Sessler CN, Ward KR (2004) Duration of action of a single, early oral application of chlorhexidine on oral microbial flora in mechanically ventilated patients: A pilot study. Heart Lung 33:83–91

    Article  PubMed  Google Scholar 

  5. Munro CL, Grap MJ (2004) Oral health and care in the intensive care unit: State of the science. Am J Crit Care 13:25–33

    PubMed  Google Scholar 

  6. Janssens JP (2005) Pneumonia in the elderly (geriatric) population. Curr Opin Pulm Med 11:226–230

    PubMed  Google Scholar 

  7. Terpenning M, Shay K (2002) Oral health is cost-effective to maintain but costly to ignore. J Am Geriatr Soc 50:584–585

    Article  PubMed  Google Scholar 

  8. Vandijck DM, Decruyenaere JM, Blot SI (2006) The value of sepsis definitions in daily ICU-practice. Acta Clin Belg 61:220–226

    Article  CAS  PubMed  Google Scholar 

  9. Labeau SO, Van de Vyver K, Brusselaers N, Vogelaers D, Blot SI (2011) Prevention of ventilator-associated pneumonia with oral antiseptics: a systematic review and meta-analysis. Lancet Infect Dis 11:845–854

    Article  CAS  PubMed  Google Scholar 

  10. Dale C, Angus JE, Sinuff T, Mykhalovskiy E (2013) Mouth care for orally intubated patients: A critical ethnographic review of the nursing literature. Intensive Crit Care Nurs 29:266–274

    Article  PubMed  Google Scholar 

  11. Brennan MT, Bahrani-Mougeot F, Fox PC, Kennedy TP, Hopkins S, Boucher RC, Lockhart PB (2004) The role of oral microbial colonization in ventilator-associated pneumonia. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 98:665–672

    Article  PubMed  Google Scholar 

  12. Berry AM, Davidson PM (2006) Beyond comfort: oral hygiene as a critical nursing activity in the intensive care unit. Intensive Crit Care Nurs 22:318–328

    Article  PubMed  Google Scholar 

  13. Woods DE, Straus DC, Johanson WG Jr, Bass JA (1981) Role of salivary protease activity in adherence of gram-negative bacilli to mammalian buccal epithelial cells in vivo. J Clin Invest 68:1435–1440

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  14. Dal Nogare AR, Toews GB, Pierce AK (1987) Increased salivary elastase precedes gram-negative bacillary colonization in postoperative patients. Am Rev Respir Dis 135:671–675

    Google Scholar 

  15. Wang PL, Azuma Y, Shinohara M, Ohura K (2001) Effect of Actinobacillus actinomycetemcomitans protease on the proliferation of gingival epithelial cells. Oral Dis 7:233–237

    Article  CAS  PubMed  Google Scholar 

  16. Pesola G (2004) Ventilator-associated pneumonia in institutionalized elders: Are teeth a reservoir for respiratory pathogens? Chest 126:1401–1403

    Article  PubMed  Google Scholar 

  17. Estes RJ, Meduri GU (1995) The pathogenesis of ventilator-associated pneumonia: I. Mechanisms of bacterial transcolonization and airway inoculation. Intensive Care Med 21:365–383

    Article  CAS  PubMed  Google Scholar 

  18. Costerton JW, Lewandowski Z, Caldwell DE, Korber DR, Lappin-Scott HM (1995) Microbial biofilms. Annu Rev Microbiol 49:711–745

    Article  CAS  PubMed  Google Scholar 

  19. Sachdev M, Ready D, Brealey D et al (2013) Changes in dental plaque following hospitalisation in a critical care unit: an observational study. Crit Care 17:R189

    Article  PubMed  Google Scholar 

  20. Barnett J (1991) A reassessment of oral healthcare. Prof Nurse 6:703–704 (706–708)

    CAS  PubMed  Google Scholar 

  21. Safdar N, Crnich CJ, Maki DG (2005) The pathogenesis of ventilator-associated pneumonia: Its relevance to developing effective strategies for prevention. Respir Care 50:725–739

    PubMed  Google Scholar 

  22. Dodek PM, Keenan S, Cook DJ et al (2004) Evidence-Based Clinical Practice Guideline for the Prevention of Ventilator-Associated Pneumonia. Annals of Internal Medicine 141:305–313

    Article  PubMed  Google Scholar 

  23. Hayes J, Jones C (1995) A collaborative approach to oral care during critical illness. Dent Health (London) 34:6–10

    Google Scholar 

  24. Jones H, Newton JT, Bower EJ (2004) A survey of the oral care practices of intensive care nurses. Intensive Crit Care Nurs 20:69–76

    Article  CAS  PubMed  Google Scholar 

  25. Amerongen AV, Veerman EC (2002) Saliva-the defender of the oral cavity. Oral Dis 8:12–22

    Article  PubMed  Google Scholar 

  26. Edgerton M, Koshlukova SE (2000) Salivary histatin 5 and its similarities to the other antimicrobial proteins in human saliva. Adv Dent Res 14:16–21

    Article  CAS  PubMed  Google Scholar 

  27. Dennesen P, van der Ven A, Vlasveld M et al (2003) Inadequate salivary flow and poor oral mucosal status in intubated intensive care unit patients. Crit Care Med 31:781–786

    Article  PubMed  Google Scholar 

  28. Holmstrup P, Poulsen AH, Andersen L, Skuldbol T, Fiehn NE (2003) Oral infections and systemic diseases. Dent Clin North Am 47:575–598

    Article  PubMed  Google Scholar 

  29. Rello J, Sole-Violan J, Sa-Borges M et al (2005) Pneumonia caused by oxacillin-resistant Staphylococcus aureus treated with glycopeptides. Crit Care Med 33:1983–1987

    Article  CAS  PubMed  Google Scholar 

  30. Koeman M, van der Ven AJ, Hak E et al (2006) Oral decontamination with chlorhexidine reduces the incidence of ventilator-associated pneumonia. Am J Respir Crit Care Med 173:1348–1355

    Article  CAS  PubMed  Google Scholar 

  31. Grap MJ, Munro CL, Ashtiani B, Bryant S (2003) Oral care interventions in critical care: Frequency and documentation. Am J Crit Care 12:113–118

    PubMed  Google Scholar 

  32. Furr LA, Binkley CJ, McCurren C, Carrico R (2004) Factors affecting quality of oral care in intensive care units. J Adv Nurs 48:454–462

    Article  Google Scholar 

  33. Rello J, Koulenti D, Blot S et al (2007) Oral care practices in intensive care units: a survey of 59 European ICUs. Intensive Care Med 33:1066–1070

    Article  PubMed  Google Scholar 

  34. Zurmehly J (2013) Oral care education in the prevention of ventilator-associated pneumonia: quality patient outcomes in the intensive care unit. J Contin Educ Nurs 44:67–75

    Article  PubMed  Google Scholar 

  35. Turk G, Kocacal Guler E, Eser I, Khorshid L (2012) Oral care practices of intensive care nurses: a descriptive study. International journal of nursing practice 18:347–353

    Article  PubMed  Google Scholar 

  36. Gmur C, Irani S, Attin T, Menghini G, Schmidlin PR (2013) Survey on oral hygiene measures for intubated patients in Swiss intensive care units. Schweizer Monatsschrift fur Zahnmedizin = Revue mensuelle suisse d'odonto-stomatologie = Rivista mensile svizzera di odontologia e stomatologia/SSO 123:394–409

    PubMed  Google Scholar 

  37. Binkley C, Furr LA, Carrico R, McCurren C (2004) Survey of oral care practices in US intensive care units. Am J Infect Control 32:161–169

    Article  PubMed  Google Scholar 

  38. Pearson LS (1996) A comparison of the ability of foam swabs and toothbrushes to remove dental plaque: implications for nursing practice. J Adv Nurs 23:62–69

    Article  CAS  PubMed  Google Scholar 

  39. Pearson LS, Hutton JL (2002) A controlled trial to compare the ability of foam swabs and toothbrushes to remove dental plaque. J Adv Nurs 39:480–489

    Article  PubMed  Google Scholar 

  40. Fourrier F, Cau-Pottier E, Boutigny H, Roussel-Delvallez M, Jourdain M, Chopin C (2000) Effects of dental plaque antiseptic decontamination on bacterial colonization and nosocomial infections in critically ill patients. Intensive Care Med 26:1239–1247

    Article  CAS  PubMed  Google Scholar 

  41. DeRiso AJ 2nd, Ladowski JS, Dillon TA, Justice JW, Peterson AC (1996) Chlorhexidine gluconate 0.12 % oral rinse reduces the incidence of total nosocomial respiratory infection and nonprophylactic systemic antibiotic use in patients undergoing heart surgery. Chest 109:1556–1561

    Article  CAS  PubMed  Google Scholar 

  42. Mori H, Hirasawa H, Oda S, Shiga H, Matsuda K, Nakamura M (2006) Oral care reduces incidence of ventilator-associated pneumonia in ICU populations. Intensive Care Med 32:230–236

    Article  PubMed  Google Scholar 

  43. Stiefel KA, Damron S, Sowers NJ, Velez L (2000) Improving oral hygiene for the seriously ill patient: implementing research-based practice. Medsurg Nurs 9:40–43

    CAS  PubMed  Google Scholar 

  44. Alhazzani W, Smith O, Muscedere J, Medd J, Cook D (2013) Toothbrushing for critically ill mechanically ventilated patients: A systematic review and meta-analysis of randomized trials evaluating ventilator-associated pneumonia. Crit Care Med 41:

    Google Scholar 

  45. Gu WJ, Gong YZ, Pan L, Ni YX, Liu JC (2012) Impact of oral care with versus without toothbrushing on the prevention of ventilator-associated pneumonia: a systematic review and meta-analysis of randomized controlled trials. Crit Care 16:R190

    Article  PubMed  Google Scholar 

  46. Munro CL, Grap MJ, Jones DJ, McClish DK, Sessler CN (2009) Chlorhexidine, toothbrushing, and preventing ventilator-associated pneumonia in critically ill adults. Am J Crit Care 18:428–437 (quiz 438)

    Article  PubMed Central  PubMed  Google Scholar 

  47. Yao LY, Chang CK, Maa SH, Wang C, Chen CC (2011) Brushing teeth with purified water to reduce ventilator-associated pneumonia. J Nurs Res 19:289–297

    Article  PubMed  Google Scholar 

  48. Labeau SO, Blot SI (2013) Oral care for mechanically ventilated patients involving toothbrushing. Crit Care Med 41:e136–e137

    Article  PubMed  Google Scholar 

  49. Labeau SO, Blot SI (2013) Toothbrushing for preventing ventilator-associated pneumonia. Crit Care 17:417

    Article  PubMed  Google Scholar 

  50. Labeau SO, Blot SI (2012) Toothbrushing does not need to reduce the risk of VAP to be indispensable. Eur J Clin Microbiol Infect Dis 31:3257–3258

    Article  CAS  PubMed  Google Scholar 

  51. Lorente L, Blot S, Rello J (2010) New issues and controversies in the prevention of ventilator-associated pneumonia. Am J Respir Crit Care Med 182:870–876

    Article  PubMed  Google Scholar 

  52. Cutler CJ, Davis N (2005) Improving oral care in patients receiving mechanical ventilation. Am J Crit Care 14:389–394

    PubMed  Google Scholar 

  53. Hanneman SK, Gusick GM (2005) Frequency of oral care and positioning of patients in critical care: a replication study. Am J Crit Care 14:378–386 (quiz 387)

    PubMed  Google Scholar 

  54. Abidia RF (2007) Oral care in the intensive care unit: a review. J Contemp Dent Pract 8:76–82

    PubMed  Google Scholar 

  55. Pobo A, Lisboa T, Rodriguez A, Sole R, Magret M, Trefler S, Gomez F, Rello J (2009) A randomized trial of dental brushing for preventing ventilator-associated pneumonia. Chest 136:433–439

    Article  PubMed  Google Scholar 

  56. Lorente L, Lecuona M, Jimenez A et al (2012) Ventilator-associated pneumonia with or without toothbrushing: a randomized controlled trial. Eur J Clin Microbiol Infect Dis 31:2621–2629

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Faculty of Education, Health and Social Work, University College Ghent, Ghent, Belgium

    S. Labeau & S. Blot

  2. Dept. of Internal Medicine, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium

    S. Blot

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  1. S. Labeau
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  2. S. Blot
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Correspondence to S. Blot .

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Editors and Affiliations

  1. Erasme Hospital, Université libre de Bruxelles, Brussels, Belgium

    Jean-Louis Vincent Prof.

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Labeau, S., Blot, S. (2014). Oral Care in Intubated Patients: Necessities and Controversies. In: Vincent, JL. (eds) Annual Update in Intensive Care and Emergency Medicine 2014. Annual Update in Intensive Care and Emergency Medicine, vol 2014. Springer, Cham. https://doi.org/10.1007/978-3-319-03746-2_10

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  • DOI: https://doi.org/10.1007/978-3-319-03746-2_10

  • Publisher Name: Springer, Cham

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