Prevention of Ventilator-associated Pneumonia by Oral Decontamination

Bergmans, Dennis C. J. J.; Bonten, M. J. M.; Gaillard, Carlo A. J. M.; Paling, J C; Geest, S. van der; Tiel, Frank H. van; Beysens, A. J. M. M.; Leeuw, Peter W. de; Stobberingh, Ellen E.

doi:10.1164/ajrccm.164.3.2005003

Cited by 309 publications

(70 citation statements)

References 26 publications

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“…Although our sample size was small, these results are suggestive of a population of high-risk patients. In a prospective, randomized, double-blind, placebocontrolled study of 226 patients, Bergmans et al 4 found that oropharyngeal colonization was a key component in the development of VAP among ICU patients. The variation in the reported rates of VAP may partially reflect the heterogeneity of patients in different types of ICUs.…”

Section: Ventilator-associated Pneumoniamentioning

confidence: 99%

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Oral Health, Ventilator-Associated Pneumonia, and Intracranial Pressure in Intubated Patients in a Neuroscience Intensive Care Unit

Prendergast

Hallberg

Jahnke

et al. 2009

American Journal of Critical Care

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Background Although oral health affects systemic health, studies of oral health during intubation among critically ill neuroscience patients are lacking. Furthermore, the effect of oral care on intracranial pressure among critically ill patients in a neuroscience intensive care unit is unknown. Objectives To describe changes in oral health and development of ventilatorassociated pneumonia during intubation among patients in a neuroscience intensive care unit and to assess the influence of oral care on intracranial pressure. Methods Data on 45 consecutive intubated patients admitted to a neuroscience intensive care unit during 1 year were collected by using oral cultures and the Oral Assessment Guide throughout intubation and 48 hours after extubation. Occurrence of ventilator-associated pneumonia and intracranial pressures associated with oral care were recorded. Results Oral health, assessed by the Oral Assessment Guide, deteriorated significantly during intubation and improved to almost baseline levels 48 hours after extubation. During intubation, occurrence of oral gram-negative bacteria and yeast increased. The incidence of ventilator-associated pneumonia was 24% among patients enrolled for 4 to 10 days. During or after 879 instances of oral care, overall intracranial pressure did not increase. Among 30 instances in which intracranial pressure was greater than 20 mm Hg before oral care, pressure decreased during and 30 minutes after the procedure (P < .001). Conclusions Intubation may contribute to worsening of oral health among patients in neuroscience intensive care units. Execution of oral care does not seem to affect intracranial pressure adversely. Oral care should be explored further to promote good oral and systemic health in patients in neuroscience intensive care units and to determine its effect on ventilator-associated pneumonia.

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Section: Ventilator-associated Pneumoniamentioning

confidence: 99%

“…1 The combination of poor oral health and airway devices may increase the risk of ventilator-associated pneumonia (VAP). 4,5 The rates of morbidity and mortality associated with VAP range from 20% to 41% in various intensive care units (ICUs).…”

mentioning

confidence: 99%

Oral Health, Ventilator-Associated Pneumonia, and Intracranial Pressure in Intubated Patients in a Neuroscience Intensive Care Unit

Prendergast

Hallberg

Jahnke

et al. 2009

American Journal of Critical Care

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“…(1,3,7,19,20) Evidence has correlated microbial colonization of the oropharynx and of the dental plaque with VAP. (1,2,6,7,9,11,12,16,17,19,(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33) Almost 50% of the healthy adults present aspiration of oropharyngeal secretion at some point during sleep; this percentage increases to 70% in cases of patients with a drop in the level of consciousness. (1,3,19) When the respiratory conditions of the patient worsen to the point of requiring intubation, resources such as MV can lead to the risk of microaspiration of pathogens to the lower respiratory tract.…”

Section: Pathogenesis Of Nosocomial Pneumonia and Importance Of The Omentioning

confidence: 99%

“…(33) A decrease of up to 40% in cases of pneumonia was observed when oral hygiene of patients was mechanically and chemically improved. (20) The efficacy of the combination of chlorhexidine and other antimicrobials, such as neomycin sulfate, gentamicin or vancomycin, has also been reported.…”

Section: Prevention Of Nosocomial Pneumonia: Importance Of Oral Hygiementioning

confidence: 99%

Pneumonia nosocomial: importância do microambiente oral

2009

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on average, 5-9 days the length of hospital stay of patients, nosocomial pneumonia markedly increases hospital costs. (5)(6)(7)(8) The use of oral antiseptic and antimicrobial agents to prevent nosocomial pneumonia has been widely studied and, based on what has been reported, the present study aimed to review the literature focusing on how oral microorganisms can influence the development of nosocomial pneumonia and on how the frequency of nosocomial pneumonia can be reduced by changing the oral environment. DefinitionsPneumonia is an acute lung infection, which can produce respiratory signs and symptoms, such as cough, short and fast breathing, production of secretion and chest pain, as well as non-specific systemic symptoms, such as fever, IntroductionPeriodontal medicine appeared based on studies that reported the direct relationship between periodontal disease and a number of systemic morbidities, such as atherosclerosis, acute myocardial infarction, preterm birth, low birth weight, respiratory problems, gastritis, endocarditis and bacteremia.(1-3) Within this group of diseases, nosocomial pneumonia has been increasingly studied, and the relationship between nosocomial pneumonia and microorganisms from the oral cavity has been increasingly acknowledged.Patients submitted to cardiac surgery have a particularly high risk of developing nosocomial pneumonia; in these patients, the incidence of nosocomial pneumonia can be as high as 20%, and the disease is significantly associated with mortality.(4) The risk of developing nosocomial pneumonia increases with the need for mechanical ventilation and, in addition to prolonging, AbstractNosocomial pneumonia, especially ventilator-associated pneumonia, is a common infection in ICUs. The main etiologic factors involve colonizing and opportunistic bacteria from the oral cavity. Oral hygiene measures, including the use of oral antiseptic agents, such as chlorhexidine, have proven useful in reducing its incidence. The objective of this article was to review the literature on the importance of the oral environment in the development of nosocomial pneumonia.Keywords: Intensive care; Oral hygiene; Cross infection; Pneumonia. ResumoA pneumonia nosocomial, em especial aquela associada à ventilação mecânica, é uma infecção frequente nas UTIs. Seus principais fatores etiológicos incluem bactérias colonizadoras e oportunistas da cavidade oral. Manobras de higiene oral, com o uso de antissépticos orais, como a clorexidina, têm se mostrado úteis na diminuição de sua incidência. O objetivo deste trabalho foi revisar a literatura sobre a importância do microambiente oral no desenvolvimento da pneumonia nosocomial.

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“…In einer weiteren Untersuchung an herzchirurgischen Patienten konnten die Häufigkeit respiratorischer Infektionen und der Antibiotikaverbrauch durch orale Spülung mit 0,12%igem Chlorhexidin gesenkt werden. Die oben genannte Untersuchung von Bergmans et al [3] unterstreicht deshalb nachdrücklich die Bedeutung der oropharyngealen Dekontamination. Es bleibt aber weiterhin unklar, ob die zusätzliche gastrale Applikation von SDD weitere Vorteil erbringt, da eine direkte Vergleichgruppe in dieser Studie fehlte.…”

Section: Bewertung Der Pneumonieprävention In Metaanalysenunclassified

Selektive Darmdekontamination in der Intensivmedizin

2003

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Selective digestive tract decontamination (SDD) is a method where topical non-absorbable antibiotics are applied to the oropharynx and stomach which primarily is aimed at the prevention of ventilator-associated pneumonia. The rationale for SDD is that ventilator associated pneumonia usually originates from the patients'own oropharyngeal microflora. SDD is also used for the prevention of gut-derived infections in acute necrotizing pancreatitis and in liver transplantation. Despite numerous clinical trials and several meta-analyses, SDD is still a controversial topic. It is now commonly accepted that the incidence of pneumonia is reduced,however, the concept of using topical antibiotics has its inherent limitations and the best results have been obtained by combination with a short course of intravenous antibiotics. Several issues surrounding the notorious difficulties in establishing the diagnosis of ventilator-associated pneumonia especially in the presence of antibiotics are an on-going matter of debate.Furthermore, pneumonia is the leading cause of death from nosocomial infections and its prevention was not adequately followed by reduced mortality in most individual trials, however, a benefit was suggested by recalculation of data in meta-analyses. Patients are not well defined by their need for ICU admission and mechanical ventilation and the attributable mortality of infections depends more on the type and severity of the underlying diseases. Recently published trials substantially improved our understanding as to which patients may derive most benefit from SDD.Currently, it seems that an improved survival can be achieved in surgical and trauma patients with severe but salvageable diseases, which might be classified e.g.by calculation of APACHE-II scores on admission.However, the most important drawback of SDD is the development of resistance and an increased selection pressure towards Gram-positive pathogens, especially in institutions with endemic multi-resistant microorganisms.Thus, it appears that "selective" must not only be interpreted as selective suppression of pathogenic bacteria but rather as selection of appropriate groups of patients with respect to underlying diseases and severity of illness. Furthermore, it means selection of ICUs where the endemic resistance patterns might allow the use of SDD at a relatively low risk for selection of resistant microorganisms, which is still the major concern associated with SDD.

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Prevention of Ventilator-associated Pneumonia by Oral Decontamination

Abstract: cross infection, prevention and control; respiration, artificial, adverse effects; antibiotics, administration and dosage infection control methods; pneumonia, etiology, prevention and control; intubation, intratracheal, adverse effects

Cited by 309 publications

References 26 publications

Oral Health, Ventilator-Associated Pneumonia, and Intracranial Pressure in Intubated Patients in a Neuroscience Intensive Care Unit

Oral Health, Ventilator-Associated Pneumonia, and Intracranial Pressure in Intubated Patients in a Neuroscience Intensive Care Unit

Pneumonia nosocomial: importância do microambiente oral

Selektive Darmdekontamination in der Intensivmedizin

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