Effects of three approaches to standardized oral hygiene to reduce bacterial colonization and ventilator associated pneumonia in mechanically ventilated patients: A randomised control trial
Effects of three approaches to standardized oral hygiene to reduce bacterial colonization and ventilator associated pneumonia in mechanically ventilated patients: A randomised control trial
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DOI：
10.1016/j.ijnurstu.2010.11.004
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发表时间：
2011-06-01
影响因子：
8.1
通讯作者：
Ollerton, R.
中科院分区：
文献类型：
--
作者：
Berry, A. M.;Davidson, P. M.;Ollerton, R.
背景：呼吸机相关性肺炎仍然是重症监护病房(ICU)的一个重要问题。越来越多的证据表明，通过实施包括优化口腔卫生在内的一系列预防策略，可以降低死亡率和发病率。目的：本可行性研究的目的是测试两种口腔卫生策略对牙菌斑与呼吸道病原体的微生物定植(主要结果)和呼吸机相关性肺炎(次要结果)的影响。方法：在一所大学医院的20张床位的成人重症监护病房进行单盲随机对照研究。预期机械通气时间超过48小时的患者符合条件。患者被随机分为三组(A组对照组，用无菌水每小时第二次口腔冲洗，B组每小时第二次碳酸氢钠口腔冲洗，C组每天两次用0.2%洗必泰含水口腔冲洗，第二次用无菌水每小时冲洗)。所有研究选项包括用牙刷清洁和用无泡沫牙膏清洁。结果：共分析了109名患者的数据。A组43例，B组33例，C组33例(平均年龄58±17岁，简化急性生理学评分11：44+/-14分)。入院时，两组间所有临床数据均无显著差异。B组在入院第4天细菌定植有明显下降趋势，但差异无统计学意义(p=0.302)。呼吸机相关性肺炎的发生率在B组和C组之间平均分布(5%)，而A组仅为1%。结论：虽然已有多项研究提倡使用不同的漱口水来减少牙菌斑的定植，但标准化的口腔卫生方案，包括使用牙刷机械清洁，可能是减少牙菌斑与呼吸道病原体定植的一个因素。这项可行性研究提供了数据，为今后的充分研究提供参考。(C)2010爱思唯尔有限公司。保留所有权利。
Background: Ventilator associated pneumonia remains an important concern in the intensive care unit (ICU). An increasing body of evidence shows that mortality and morbidity can be reduced by implementing a range of preventive strategies, including optimizing oral hygiene.Aim: The aim of this feasibility study was to test two oral hygiene strategies on the effects of microbial colonization of dental plaque with respiratory pathogens (primary outcome) and incidence of ventilator associated pneumonia (secondary outcome).Methods: A single blind randomised comparative study was conducted in a 20-bed adult intensive care unit in a university hospital. Patients with an expected duration of mechanical ventilation more than 48 h were eligible. Patients were randomised to one of three study regimens (Group A control, second hourly oral rinse with sterile water, Group B sodium bicarbonate mouth wash second hourly, and Group C twice daily irrigations with chlorhexidine 0.2% aqueous oral rinse and second hourly irrigations with sterile water). All study options included cleaning with a toothbrush and non foaming toothpaste.Results: Data from a total of 109 patients were analyzed. Group A 43, Group B 33 and Group C 33 (mean age: 58 +/- 17 years, simplified acute physiology score 11: 44 +/- 14 points). On admission no significant differences were found between groups for all clinical data. While Group B showed a greater trend to reduction in bacterial colonization no significant differences could be demonstrated at Day 4 of admission (p = 0.302). The incidence of ventilator associated pneumonia was evenly spread between Groups B and C (5%) while Group A was only 1%.Conclusions: While a number of studies have advocated the use of various mouth rinses in reducing colonization of dental plaque a standardized oral hygiene protocol which includes the use of mechanical cleaning with a toothbrush may be a factor in the reduction of colonization of dental plaque with respiratory pathogens. This feasibility study provides data to inform future adequately powered studies. (C) 2010 Elsevier Ltd. All rights reserved.