Oral Lesions Associated with Orotracheal Administered Mechanical Ventilation in Critically III Dogs

Abstract

he incidenceand clinicalprocession OJoral lesions in a cohort @ critical~ill patients administered mechanicalventi~ationvia orotracheaiincubationwere observedprospectivelyin the Intensive CareUnit (icu) o~the Universi@@ Cal#omia,Davis Veterinay MedicalPaching Hospital. Oralcavitzes@ these patients wereexamined within 24 hours #being placed on the ventilatorand at least dai~there@er during ventilatortherapy.As part oJthe study protocol any lesionnoted was tieated. Tiventy-oneC?ihcally ill caninepatien~(median qge OJ7yrs; range c1 to 19 yrs) were observed~om 1 January 1995 through 31 August 1995. Overninep percent (90.5%) of the observedpatients developedoral lesionssubsequent to being mechanica! (yventilated,Erosiveand ulcerativemucosa[lesionswerethe mostfiequent~observed (15/43) with the tongue bang the most~equently involved ora[structure.Most @the observedso> tissue oral lesionsappearedsecondaryto persistent~appliedpressure~om teeth, mouthgtgs, endotracheal tubes, and other monitonng devices.Eforts taken to prevent persistent~appliedtiauma, such as periodic posifiona[changes oJequipment and padding oJsusceptiMes&uctures,appearede~ectivein preventirig oral lesions. Therewere indicationsojgastric reJux in 6 pafients (28. 6%), as evidencedby secretionsin the oralcavip with a pH 0J<6 and containingdigestedblood. Ulcerativelesions in the subset oJpa&"ents withgastric reJhx seemedto worsenin seven"~with exposureto the lowpH secretions.Overthe courseof the study, the KU nursing stay developedan e~ectiveprotocol~or the care OJthe oral cavip: treating mucosalerosionsand ulcerstopically with a dilute chlorhexidineso [uh'on(O. 05%), removingoral secretions via suction as needed,and padding persistent~traumaozed fissues with g~cenh moistenedgauze. Oraliesions in orotracheallyintubated and mechanicallyven~latedpatients are predictable,preventable, and treatable.Most lesionsarepressure induced, assoa"atedwith monitonn@herapeutik equipment and appearto bepreventablewith appropn'ate nursingprotocols Most observedorallesionsclinicallyimproved with routzne,pen"odic dilute ch!orhexidinen"nsesand reiieJoJappliedpressure.

Nursing Care of the Long‐Term Anesthetized Patient

“…1,3,11,13 The ET tube tie should be adjusted every 6 hours. A cushion made of saline-or glycerin-moistened gauze should be placed between the tie and the soft tissues it comes into contact with.…”

“…A cushion made of saline-or glycerin-moistened gauze should be placed between the tie and the soft tissues it comes into contact with. 3,11,13 If possible, placement of the tongue directly over the teeth should be avoided. 3,11,13 If this is not possible, the teeth should be packed with saline-or glycerin-moistened gauze to reduce trauma (Fig.…”

“…SOD refers to the use of topical antibiotics in the oral cavity and has been shown to reduce mortality in human critical care patients, due to reduction in oropharyngeal bacterial colonization. 13,31 Persistent regurgitation may further complicate oral care. Aspiration of gastric contents is a cause of VAP.…”

“…12 This change in oral flora from gram positive to gram negative occurs in mechanically ventilated human patients within 48-72 hours of ICU admission. 13 These bacteria are frequently the causative agents of ventilatorassociated pneumonia (VAP).…”

“…Oral ulcers are often caused by mechanical injury to the structures of the mouth. 13 Persistent pressure from pulse oximeter probes, mouth gags, ET tube and its tie, applied to the tongue and other soft tissue structures leads to ulceration. 13…”