The Main Effects of the Original Oral Care Protocol Implementation in Patients on Invasive Mechanical Ventilation
Respiratory infection is the most common nosocomial infection found in intensive care units (ICUs). Dental plaques and oral mucosa can be colonized by respiratory pathogens within a few days after tracheal intubation. Oral care plays an important role in reducing the incidence of ventilator-associat...
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Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow, Russia
2024-09-01
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| Series: | Общая реаниматология |
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| Online Access: | https://www.reanimatology.com/rmt/article/view/2508 |
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| author | I. N. Leyderman A. О. Marichev I. U. Kasherininov N. A. Lesteva A. D. Ponomareva A. О. Sivcov D. V. Ryabova M. М. Nosenko G. A. Ablesimov |
| author_facet | I. N. Leyderman A. О. Marichev I. U. Kasherininov N. A. Lesteva A. D. Ponomareva A. О. Sivcov D. V. Ryabova M. М. Nosenko G. A. Ablesimov |
| author_sort | I. N. Leyderman |
| collection | DOAJ |
| description | Respiratory infection is the most common nosocomial infection found in intensive care units (ICUs). Dental plaques and oral mucosa can be colonized by respiratory pathogens within a few days after tracheal intubation. Oral care plays an important role in reducing the incidence of ventilator-associated infections.Aim of the study. To evaluate clinical effectiveness of the original oral care protocol in ICU patients on invasive mechanical ventilation (IMV).Materials and Methods. A multicenter, open-label, randomized, prospective, controlled study was conducted in 55 surgical ICU patients on long-term mechanical ventilation. Oral care for patients in the study group (group 1, N=30) included brushing with disposable toothbrushes and rinsing with an aqueous solution of 0.05% chlorhexidine digluconate three times daily. In the control group (group 2, N=25), patients' oral care was performed twice a day using sterile cotton swabs soaked in 0.05% aqueous chlorhexidine digluconate solution. The results were statistically processed using IBM SPSS Statistics 21. The relative risk (RR) of events was calculated with a 95% confidence interval (95% CI). The 95% CIs for event density parameters such as incidence rate (IR) and incidence rate ratio (IRR) were calculated using the exact Poisson test.Results. The incidence of ventilator-associated pneumonia (VAP) was 13.6 cases [95% CI: 4.4; 31.7] per 1,000 ventilation days in group 1 and 23.6 cases [95% CI: 7.7; 55] per 1,000 ventilation days in group 2. The incidence of VAP was 1.74 times lower [95% CI: 0.4, 7.54] in group 1 vs. group 2 (P=0.398). The identity of oral and tracheal flora on day 7 was 20% in group 1 and 50% in group 2, RR=0.4, 95% CI: 0.165–0.973, P=0.037. Serum C-reactive protein levels were significantly lower in group 1 on day 7 of ventilation compared to group 2 (P=0.04).Conclusion. The original oral care protocol, based on toothbrushing 3 times daily with a set of disposable toothbrushes and 0.05% aqueous solution of chlorhexidine digluconate, is associated with a tendency to lower VAP incidence per 1000 days of ventilation, significantly lower similarity between oral and tracheal flora, and lower serum C-reactive protein levels on day 7 of IMV. Further research on various aspects of oral care in ICU patients is needed, especially in the absence of complete clinical guidelines and clearly effective strategies for the prevention of ventilator-associated infections. |
| format | Article |
| id | doaj-art-ee9c8950ce4949feb6c366b81bccdbe8 |
| institution | Kabale University |
| issn | 1813-9779 2411-7110 |
| language | English |
| publishDate | 2024-09-01 |
| publisher | Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow, Russia |
| record_format | Article |
| series | Общая реаниматология |
| spelling | doaj-art-ee9c8950ce4949feb6c366b81bccdbe82025-08-20T03:59:40ZengFederal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow, RussiaОбщая реаниматология1813-97792411-71102024-09-01204394710.15360/1813-9779-2024-4-23841962The Main Effects of the Original Oral Care Protocol Implementation in Patients on Invasive Mechanical VentilationI. N. Leyderman0A. О. Marichev1I. U. Kasherininov2N. A. Lesteva3A. D. Ponomareva4A. О. Sivcov5D. V. Ryabova6M. М. Nosenko7G. A. Ablesimov8V. A. Almazov National Medical Research Center, Ministry of Health of RussiaV. A. Almazov National Medical Research Center, Ministry of Health of RussiaV. A. Almazov National Medical Research Center, Ministry of Health of RussiaV. A. Almazov National Medical Research Center, Ministry of Health of RussiaV. A. Almazov National Medical Research Center, Ministry of Health of RussiaMedical and Sanitary Unit «Neftyanik»B. V. Petrovsky Russian Research Center for SurgeryCity Clinical Hospital № 17, Moscow City Health DepartmentV. A. Almazov National Medical Research Center, Ministry of Health of RussiaRespiratory infection is the most common nosocomial infection found in intensive care units (ICUs). Dental plaques and oral mucosa can be colonized by respiratory pathogens within a few days after tracheal intubation. Oral care plays an important role in reducing the incidence of ventilator-associated infections.Aim of the study. To evaluate clinical effectiveness of the original oral care protocol in ICU patients on invasive mechanical ventilation (IMV).Materials and Methods. A multicenter, open-label, randomized, prospective, controlled study was conducted in 55 surgical ICU patients on long-term mechanical ventilation. Oral care for patients in the study group (group 1, N=30) included brushing with disposable toothbrushes and rinsing with an aqueous solution of 0.05% chlorhexidine digluconate three times daily. In the control group (group 2, N=25), patients' oral care was performed twice a day using sterile cotton swabs soaked in 0.05% aqueous chlorhexidine digluconate solution. The results were statistically processed using IBM SPSS Statistics 21. The relative risk (RR) of events was calculated with a 95% confidence interval (95% CI). The 95% CIs for event density parameters such as incidence rate (IR) and incidence rate ratio (IRR) were calculated using the exact Poisson test.Results. The incidence of ventilator-associated pneumonia (VAP) was 13.6 cases [95% CI: 4.4; 31.7] per 1,000 ventilation days in group 1 and 23.6 cases [95% CI: 7.7; 55] per 1,000 ventilation days in group 2. The incidence of VAP was 1.74 times lower [95% CI: 0.4, 7.54] in group 1 vs. group 2 (P=0.398). The identity of oral and tracheal flora on day 7 was 20% in group 1 and 50% in group 2, RR=0.4, 95% CI: 0.165–0.973, P=0.037. Serum C-reactive protein levels were significantly lower in group 1 on day 7 of ventilation compared to group 2 (P=0.04).Conclusion. The original oral care protocol, based on toothbrushing 3 times daily with a set of disposable toothbrushes and 0.05% aqueous solution of chlorhexidine digluconate, is associated with a tendency to lower VAP incidence per 1000 days of ventilation, significantly lower similarity between oral and tracheal flora, and lower serum C-reactive protein levels on day 7 of IMV. Further research on various aspects of oral care in ICU patients is needed, especially in the absence of complete clinical guidelines and clearly effective strategies for the prevention of ventilator-associated infections.https://www.reanimatology.com/rmt/article/view/2508oral caremechanical ventilationinfectious complicationsventilator-associated pneumoniadisposable toothbrushescotton swabs |
| spellingShingle | I. N. Leyderman A. О. Marichev I. U. Kasherininov N. A. Lesteva A. D. Ponomareva A. О. Sivcov D. V. Ryabova M. М. Nosenko G. A. Ablesimov The Main Effects of the Original Oral Care Protocol Implementation in Patients on Invasive Mechanical Ventilation Общая реаниматология oral care mechanical ventilation infectious complications ventilator-associated pneumonia disposable toothbrushes cotton swabs |
| title | The Main Effects of the Original Oral Care Protocol Implementation in Patients on Invasive Mechanical Ventilation |
| title_full | The Main Effects of the Original Oral Care Protocol Implementation in Patients on Invasive Mechanical Ventilation |
| title_fullStr | The Main Effects of the Original Oral Care Protocol Implementation in Patients on Invasive Mechanical Ventilation |
| title_full_unstemmed | The Main Effects of the Original Oral Care Protocol Implementation in Patients on Invasive Mechanical Ventilation |
| title_short | The Main Effects of the Original Oral Care Protocol Implementation in Patients on Invasive Mechanical Ventilation |
| title_sort | main effects of the original oral care protocol implementation in patients on invasive mechanical ventilation |
| topic | oral care mechanical ventilation infectious complications ventilator-associated pneumonia disposable toothbrushes cotton swabs |
| url | https://www.reanimatology.com/rmt/article/view/2508 |
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