Year: 2014
Type: article
Study design: Observational Study
Abstract: Ventilator-associated pneumonia (VAP) is the leadingcause of morbidity and mortality in the ICU, particularly in older
patients. Strategies to reduce or prevent the incidence of VAP are
crucial. One of the less understood risk factors for VAP is poor
oral health. This study provided the first evaluation of
preoperative oral health status as a risk factor for
ventilator-associated pneumonia in older adults. While oral health,
dental plaque and oral bacteria have been suggested in the
literature as linked to VAP, the association between amount of
plaque before and after surgery and VAP risk has not previously
been directly studied. The model used to guide this study is based
on the Human Response Model (HRM) of Heitkemper and Shaver. A
prospective, correlational design was used to measure the
relationship between oral health and VAP. A convenience sample of
96 adults over 50 years old were recruited from patients scheduled
for elective cardiac, abdominal, thoracic or vascular surgery, who
required oral intubation and mechanical ventilation post-surgery.
Oral health was evaluated by dental plaque accumulation using the
University of Mississippi Oral Hygiene Index (UM-OHI). VAP was
diagnosed using the Clinical Pulmonary Infection Score (CPIS)
within 24 hours of intubation and up until postoperative day seven.
Multiple and logistic regression analysis indicated that
preoperative oral health significantly predicted postoperative oral
health and accounted for 64% of the variability in postoperative
oral health. Overall, oral health declined from preoperative to
postoperative but deteriorated less in cardiac surgery patients.
Higher patient acuity, greater number of comorbidities and being
female was associated with an increased likelihood of developing
ventilator-associated pneumonia. Although this study did show a
decline in oral health from preoperative to postoperative, it did
not find a direct relationship between the quantity of dental
plaque and VAP. This study did find that VAP risk is likely related
to preoperative comorbidities and vulnerabilities, and to hospital
acuity and course. A VAP reduction strategy which focuses on plaque
quantity reduction as its target may not be effective. This study
can serve as a basis for future studies investigating the impact of
oral health on ventilator-associated pneumonia.
Author: Gina Maria Luciano
Institution: Case Western Reserve University
Language: English
Topic: Nosocomial Infections in ICU
Field: Medicine
Domain: Health Sciences
Open Access status: green
Funder: Cleveland Clinic
OpenAlex ID: W2236256546