Oral health status and development of ventilator-associated pneumonia: a descriptive study

• Published in: American journal of critical care Vol. 15; no. 5; pp. 453 - 460
• Main Authors: Munro, Cindy L, Grap, Mary Jo, Elswick, Jr, R K, McKinney, Jessica, Sessler, Curtis N, Hummel, 3rd, Russell S
• Format: Journal Article
• Language: English
• Published: United States American Association of Critical-Care Nurses 01-09-2006; American Association of Critical - Care Nurses
• Subjects: Bacterial pneumonia; Complications and side effects; Critical Illness; Dental plaque; Dental Plaque - microbiology; Diagnosis; Female; Health Status; Humans; Intubation, Intratracheal - adverse effects; Longitudinal Studies; Male; Management; Middle Aged; Mouth Mucosa - microbiology; Nursing; Nursing care; Oral Health; Oral Hygiene; Pneumonia; Pneumonia, Ventilator-Associated - microbiology; Prevention; Regression Analysis; Risk Factors; Saliva - secretion; Time Factors; United States
• ISSN: 1062-3264; 1937-710X
• DOI: 10.4037/ajcc2006.15.5.453

Ventilator-associated pneumonia is a significant cause of morbidity and mortality and may be influenced by oral health.
To describe the relationship between ventilator-associated pneumonia and oral health status, changes in oral health status during the first 7 days after intubation, and microbial colonization of the oropharynx and trachea.
A total of 66 patients were enrolled within 24 hours of intubation and were followed up for up to 7 days. Data on oral health measures and the Clinical Pulmonary Infection Score (CPIS) were collected at baseline, day 4 (n = 37), and day 7 (n = 21). A regression model was used to predict risk of pneumonia at day 4.
Dental plaque and oral organisms increased over time. Correlations were significant for baseline and day 4 dental plaque (P < .001), baseline salivary lactoferrin and day 4 plaque (P = .01), and lower salivary volume and higher day 4 CPIS (P = .02). Potential pathogens were identified in oral cultures for 6 patients before or at the same time as the appearance of the organisms in tracheal aspirates. Correlations were significant with day 4 CPIS for score on the Acute Physiology and Chronic Health Evaluation (APACHE) II (P = .007), day 4 salivary volume (P = .02), interaction of APACHE II score and day 1 CPIS (P<.001), and interaction of day 1 CPIS and plaque (P=.01).
Higher dental plaque scores confer greater risk for ventilator-associated pneumonia, particularly for patients with greater severity of illness. Salivary volume and lactoferrin may affect the risk.