Prevention of mechanical ventilator-associated pneumonia: a comparison of two different oral hygiene methods

Introduction: Oral hygiene (OH) forms a part of the patient's safety in the prevention of mechanical ventilator-associated pneumonia (VAP). The dental plaque index (DP) is considered as a quality marker for OH. Hypothesis: The association of electric toothbrush and conventional OH in intubated patients decreases the DP and incidence of VAP. Objective: To verify the reduction of DP in patients receiving OH and electric toothbrush and its association with to the decrease of VAP incidence. Materials and methods: A 3-year long randomized, single blind and prospective study conducted in a 14-bed polyvalent intensive care unit. Patients were included when there was more than 48 hours of mechanical ventilation and no expected respiratory infection. Patients were randomized into two groups: Standard (OH with chlorhexidine) (GS) and Raspall (Standard OH with electric dental brush) (GR). The VAP was identified following clinical, medical and microbiological criteria. The DP and halitosis were observed daily. Oral and pharyngeal swabs were collected during the first 5 days. Results: 147 patients were included. Mean age was 53.9 +/- 17.5. No significant differences were found in the VAP incidence between the two groups (OR = 0.78; 95% IC, 0.36-1.68; p = 0.56). The relation between halitosis and DP was p = 0.7. The dental plaque index on the 5th day was 1.98 (n = 60) in GR and 2.04 (n = 57) in GS (p = 0.3). The dental plaque index on the 10th day was 1.68 (n = 29) in GR and 1.91 (n = 32) in GS (p = 0.7). Conclusions: There is a tendency towards a decrease in the DP which is clearing in the GR group and no relation between VAP and greater DP or halitosis. (c) 2010 Elsevier Espana, S.L. and SEEIUC. All rights reserved.