Aspiration Prevention Protocol: Decreasing Postoperative Pneumonia in Heart Surgery Patients

Starks, Bobbie; Harbert, Christy

doi:10.4037/ccn2011462

Cited by 24 publications

(26 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Studies have examined general prognostic indicators of swallowing function in different diseases. These indicators include: age [20,21]; severity of the disease [22-24]; cognitive status [18,25]; dysphagia severity level at hospital admission and/or discharge [22,26-28]; presence of feeding tube [29]; time to achieve oral feeding status [14,17,30]; time to tracheostomy weaning [14,31]; ventilator status [17,25]; amount of treatment [14,18,26]; and length of hospital stay [12,32]. …”

Section: Introductionmentioning

confidence: 99%

Clinical prognostic indicators of dysphagia following prolonged orotracheal intubation in ICU patients

et al. 2013

View full text Add to dashboard Cite

IntroductionThe development of postextubation swallowing dysfunction is well documented in the literature with high prevalence in most studies. However, there are relatively few studies with specific outcomes that focus on the follow-up of these patients until hospital discharge. The purpose of our study was to determine prognostic indicators of dysphagia in ICU patients submitted to prolonged orotracheal intubation (OTI).MethodsWe conducted a retrospective, observational cohort study from 2010 to 2012 of all patients over 18 years of age admitted to a university hospital ICU who were submitted to prolonged OTI and subsequently received a bedside swallow evaluation (BSE) by a speech pathologist. The prognostic factors analyzed included dysphagia severity rate at the initial swallowing assessment and at hospital discharge, age, time to initiate oral feeding, amount of individual treatment, number of orotracheal intubations, intubation time and length of hospital stay.ResultsAfter we excluded patients with neurologic diseases, tracheostomy, esophageal dysphagia and those who were submitted to surgical procedures involving the head and neck, our study sample size was 148 patients. The logistic regression model was used to examine the relationships between independent variables. In the univariate analyses, we found that statistically significant prognostic indicators of dysphagia included dysphagia severity rate at the initial swallowing assessment, time to initiate oral feeding and amount of individual treatment. In the multivariate analysis, we found that dysphagia severity rate at the initial swallowing assessment remained associated with good treatment outcomes.ConclusionsStudies of prognostic indicators in different populations with dysphagia can contribute to the design of more effective procedures when evaluating, treating, and monitoring individuals with this type of disorder. Additionally, this study stresses the importance of the initial assessment ratings.

show abstract

Section: Introductionmentioning

confidence: 99%

Clinical prognostic indicators of dysphagia following prolonged orotracheal intubation in ICU patients

et al. 2013

View full text Add to dashboard Cite

show abstract

“…Bacterial colonization of oropharyngeal tissues and dental plaque are major precursors to the development of respiratory infection [39]. Implementing protocols to prevent aspiration and improve oral hygiene reduces the occurrence of PP in patients after cardiac surgery [40,41]. Although simple comparisons are not appropriate because of differences in the definition of PP and study populations among previously reported studies, the reported incidence of PP after cardiac surgery is between 2% and 10%, especially during the first week after surgery [42].…”

Section: Oral Hygiene and Postoperative Pneumoniamentioning

confidence: 99%

“…Some studies have evaluated the efficacy of strict perioperative oral management in patients undergoing cardiac surgery. Starks and Harbert [40] reported that the incidence of PP after cardiothoracic surgery was 11% before implementation of an aspiration prevention protocol that included strict oral care; after implementation of the protocol, no patients developed PP. Bergan et al [41] reported in their single-arm prospective intervention study that the incidence of PP following cardiac surgery was 8% (18/226 patients who underwent valve surgery or CABG) after improvement in perioperative oral health through tooth-and tongue-brushing instruction and routine oral rinsing with chlorhexidine gluconate.…”

Section: Oral Hygiene and Postoperative Pneumoniamentioning

confidence: 99%

“…Oral care intervention seems to be important for the prevention of PP in cardiovascular surgery patients. Although previous studies have described the detailed procedure of oral care [39,40], appropriate procedures remain undetermined. A meta-analysis by Klompas et al [47] comparing cardiac versus non-cardiac surgery patients noted that cautions about the effect of chlorhexidine in preventing VAP are warranted: routine oral care with oral antiseptic (chlorhexidine) prevents nosocomial pneumonia only in cardiac surgery patients and may not decrease the risk of VAP in non-cardiac surgery patients.…”

Section: Strategy For Perioperative Oral Intervention In Cardiovasculmentioning

confidence: 99%

See 1 more Smart Citation

Perioperative intervention by oral medicine team in cardiovascular surgery patients

Akashi

Nanba

Kusumoto

et al. 2018

Gen Thorac Cardiovasc Surg

View full text Add to dashboard Cite

In brief, perioperative oral intervention consists of elimination of odontogenic foci and maintenance of oral hygiene in patients undergoing surgery. The importance of oral intervention before, during, and after medical treatments is well known, especially in cancer patients, because odontogenic foci such as untreated deep dental caries or periodontitis can cause systemic infection in patients with myelosuppression resulting from chemotherapy. Although perioperative oral intervention is currently recommended for patients with cardiovascular disease, its efficacy in this population has not been established. This article consists of three sections: first, we review the current knowledge about the association between dental disease and cardiovascular disease to show the importance of oral hygiene maintenance and the risks of invasive dental procedures in patients with cardiovascular disease; second, we introduce pertinent but limited evidence concerning the effect of oral care in preventing postoperative pneumonia; and finally, we present the optimal strategy for perioperative oral intervention in cardiovascular surgery patients.

show abstract

“…A intubação prolongada, descrita na literatura como uma intubação que se mantém por um período superior a 48 horas 1 ; gravidade da doença de base 22,23,24 ; estado cognitivo 18,25 ; gravidade da disfagia no momento da admissão hospitalar e/ou alta hospitalar 22,26,27,28 ; presença da sonda de alimentação 29 ; tempo para iniciar a alimentação por via oral 14,17,30 ; tempo para a decanulação da traqueostomia 14,31 ; estado ventilatório 17,25 ; quantidade de tratamento 14,18,26 ; tempo de permanência hospitalar 12,32 .…”

unclassified

Indicadores de prognósticos clínicos de deglutição funcional em pacientes de um hospital público de grande porte

Moraes¹

View full text Add to dashboard Cite

show abstract

Aspiration Prevention Protocol: Decreasing Postoperative Pneumonia in Heart Surgery Patients

Cited by 24 publications

References 19 publications

Clinical prognostic indicators of dysphagia following prolonged orotracheal intubation in ICU patients

Clinical prognostic indicators of dysphagia following prolonged orotracheal intubation in ICU patients

Perioperative intervention by oral medicine team in cardiovascular surgery patients

Indicadores de prognósticos clínicos de deglutição funcional em pacientes de um hospital público de grande porte

Contact Info

Product

Resources

About