Relationships Between Oral-Mucosal Pressure Ulcers, Mechanical Conditions, and Individual Susceptibility in Intubated Patients Under Intensive Care: A PCR-Based Observational Study

Abstract

Purpose: This study was performed to determine the relationship between oral-mucosal pressure ulcer (PU) stage and mechanical conditions and individual susceptibility in intubated patients. Methods: We collected 80 patient-days data from an intensive care unit of a 700-bed hospital in Korea. We analyzed oral-mucosal PUs, medical records, amount of saliva, and oral mucosal swabs. Bacterial abundance was enumerated by real-time polymerase chain reaction. The χ2 or Fisher’s exact test, t-test or Mann-Whitney U test, and Spearman’s rho correlation analysis were performed. Results: The incidence of overall oral-mucosal PUs was 31.3%, and in the maxillary and mandibular sites were 16.3% and 26.3%, respectively. There were significant correlations between the maxillary site PU stage and restraint use (r = .43, p < .001), albumin level (r = −.22, p = .046), and relative abundance of P. aeruginosa (r = .45, p < .001) and S. aureus (r = −.24, p = .033). In the mandibular sites, there were significant correlations between PU stage and restraint use (r = .30, p = .008), level of consciousness (r = .31, p = .005), and relative abundance of P. aeruginosa (r = .25, p = .028) and S. pneumoniae (r = .22, p = .046). Conclusions: Frequent monitoring and repositioning the mechanical pressure on the oral-mucosa could be an effective preventive strategy against the development and advancement of oral-mucosal PUs. Additionally, monitoring the oral microorganisms can prevent advanced stage oral-mucosal PUs in intubated patients.

Complications during mechanical ventilation—A pediatric intensive care perspective

“…The most common cause of medical device-related pressure ulcer are the mucosal pressure ulcers caused by prolonged pressure from endotracheal tubes ( 11 ). When compared to adult ICUs, the duration of intubation and invasive mechanical ventilation is longer in pediatric ICUs and the threshold for tracheostomy is much higher.…”

Simultaneous Analysis of Bacterial and Fungal Communities in Oral Samples from Intubated Patients in Intensive Care Unit

“…To quantify bacterial and fungal abundance, real-time PCR was applied using speciesspecific primers for VAP-associated pathogens, including Acinetobacter baumannii, Pseudomonas aeruginosa, S. aureus, S. epidermidis, and C. albicans (Table S2) [3]. The reaction conditions used for DNA amplification were 95 • C for 10 min followed by 40 cycles of 95 • C for 30 s and 60 • C for 30 s. The analyses were conducted using an RT-PCR system (Thermo Fisher Scientific, Waltham, MA, USA).…”

“…Total bacteria abundances were determined using universal 16S rRNA, and total fungal abundances using 18S rRNA. The relative abundances of targets were calculated using the ∆∆Ct method using 16S rRNA for normalization [3].…”

“…Oral bacterial and fungal communities play important roles in various nosocomial infections such as ventilator-associated pneumonia (VAP) [1], hospital-acquired pneumonia (HAP) [2], oral mucositis [3], and systemic infections [4]. In the case of VAP, the microaspiration of oropharyngeal microbes is believed to play a role in the etiology of ventilator-associated pneumonia (VAP) [2], and the prevalence of oral colonization by VAP-associated pathogens such as Pseudomonas aeruginosa, Enterobacteriacea, Acinetobacter, S. aureus, and Streptococcus spp.…”

Óleo ozonizado como terapia complementar em necrose de língua por droga vasoativa – um relato de caso em paciente crítico

“…As LPPs são causadas pela pressão prolongada ou cisalhamento do tubo orotraqueal nos tecidos moles da boca, ocasionando áreas de ulceração e até necrose, pioradas pelo ressecamento das mucosas e consequente aumento da fricção do tubo com os tecidos bucais. Além disso, a hipossalivação pode aumentar o risco de infecções, o que atrasa a cicatrização dos tecidos traumatizados (TIKKA;HILMI, 2019;KIM et al, 2021).…”