Electric Versus Manual Tooth Brushing among Neuroscience ICU Patients: Is it Safe?

Prendergast, Virginia; Hagell, Peter; Hallberg, Ingalill Rahm

doi:10.1007/s12028-011-9502-2

Cited by 18 publications

(16 citation statements)

References 19 publications

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“…The remaining eight were retrieved for full text review, and four of them were excluded because one did not report outcomes of interest [16], one pertained to electric rather than manual toothbrushing [17], one was currently ongoing [18], and one was duplicated data [19]. Thus, four RCTs were included in the final analysis [20-23].…”

Section: Resultsmentioning

confidence: 99%

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

Gong

Pan

et al. 2012

Crit Care

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IntroductionVentilator-associated pneumonia (VAP) remains a common hazardous complication in mechanically ventilated patients and is associated with increased morbidity and mortality. We undertook a systematic review and meta-analysis of randomized controlled trials to assess the effect of toothbrushing as a component of oral care on the prevention of VAP in adult critically ill patients.MethodsA systematic literature search of PubMed and Embase (up to April 2012) was conducted. Eligible studies were randomized controlled trials of mechanically ventilated adult patients receiving oral care with toothbrushing. Relative risks (RRs), weighted mean differences (WMDs), and 95% confidence intervals (CIs) were calculated and heterogeneity was assessed with the I2 test.ResultsFour studies with a total of 828 patients met the inclusion criteria. Toothbrushing did not significantly reduce the incidence of VAP (RR, 0.77; 95% CI, 0.50 to 1.21) and intensive care unit mortality (RR, 0.88; 95% CI, 0.70 to 1.10). Toothbrushing was not associated with a statistically significant reduction in duration of mechanical ventilation (WMD, -0.88 days; 95% CI, -2.58 to 0.82), length of intensive care unit stay (WMD, -1.48 days; 95% CI, -3.40 to 0.45), antibiotic-free day (WMD, -0.52 days; 95% CI, -2.82 to 1.79), or mechanical ventilation-free day (WMD, -0.43 days; 95% CI, -1.23 to 0.36).ConclusionsOral care with toothbrushing versus without toothbrushing does not significantly reduce the incidence of VAP and alter other important clinical outcomes in mechanically ventilated patients. However, the results should be interpreted cautiously since relevant evidence is still limited, although accumulating. Further large-scale, well-designed randomized controlled trials are urgently needed.

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Section: Resultsmentioning

confidence: 99%

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

Gong

Pan

et al. 2012

Crit Care

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“…One report was translated from Spanish to English to evaluate eligibility (37). Of 14 potentially eligible studies, we excluded one Low risk of bias High study of toothbrushing which did not randomize patients (45); two studies that started as randomized trials but which became observationalstudies following low enrolment (46) or apparently large treatment effect (47), neither of which reported numerators or denominators; two trials that reported dental plaque but not VAP and that focused on the outcome of intracranial pressure (48,49); and three trials using toothbrushing as part of a standard oral care protocol in both groups testing chlorhexidine vs. control (50,51) or chlorhexidine vs. bicarbonate vs. control (52). Agreement on trial selection was 100%.…”

Section: Trial Identificationmentioning

confidence: 99%

Toothbrushing for Critically Ill Mechanically Ventilated Patients

Alhazzani

Smith

Muscedere

et al. 2013

Critical Care Medicine

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In intubated, mechanically ventilated critically ill patients, toothbrushing did not significantly reduce the risk of ventilator-associated pneumonia overall. Toothbrushing has no effect on mortality or length of stay. Electric and manual toothbrushing seem to have similar effects. More research is needed on this aspect of oral care to evaluate its potential to decrease ventilator-associated pneumonia.

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“…[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.…”

Section: Review Of Literaturementioning

confidence: 99%

Effects of Nursing Interventions on Intracranial Pressure

Olson

McNett

Lewis

et al. 2013

American Journal of Critical Care

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Background Intracranial pressure is a frequent target for goaldirected therapy to prevent secondary brain injury. In critical care settings, nurses deliver many interventions to patients having intracranial pressure monitored, yet few data documenting the immediate effect of these interventions on intracranial pressure are available. Objective To examine the relationship between intracranial pressure and specific nursing interventions observed during routine care. Methods Secondary analysis of prospectively collected observational data. Results During 3118 minutes of observation, 11 specific nursing interventions were observed for 28 nurse-patient dyads from 16 hospitals. Family members talking in the room, administering sedatives, and repositioning the patient were associated with a significantly lower intracranial pressure. However, intracranial pressure was sometimes higher, lower, or unchanged after each intervention observed. Conclusion Response of intracranial pressure to nursing interventions is inconsistent. Most interventions were associated with inconsistent changes in intracranial pressure at 1 or 5 minutes after the intervention.

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Electric Versus Manual Tooth Brushing among Neuroscience ICU Patients: Is it Safe?

Abstract: Background: Poor oral hygiene has been associated with ventilator-acquired

Cited by 18 publications

References 19 publications

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

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

Toothbrushing for Critically Ill Mechanically Ventilated Patients

Effects of Nursing Interventions on Intracranial Pressure

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