Oral care reduces incidence of ventilator-associated pneumonia in ICU populations
Oral care reduces incidence of ventilator-associated pneumonia in ICU populations
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DOI：
10.1007/s00134-005-0014-4
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发表时间：
2006-02-01
影响因子：
38.9
通讯作者：
Nakamura, M
中科院分区：
文献类型：
--
作者：
Mori, H;Hirasawa, H;Nakamura, M
目的：研究口腔护理是否有助于预防ICU患者的呼吸机相关性肺炎（VAP）。设计：历史对照的非随机试验。设置：一所大学医院的内科-外科ICU。患者：1，666名入住ICU的机械通气患者。干预：1997年1月至2002年12月期间，为1，252名入住ICU的患者提供口腔护理1995年1月至1996年12月期间入住ICU且未接受口腔护理的414例患者作为历史对照测量和结果：口腔护理组的VAP发生率（每1000个呼吸机日的肺炎发作）显著低于非口腔护理组（3.9 vs 10.4）。口腔护理组与非口腔护理组相比，VAP的相对危险度为0.37，归因危险度为-3.96%。此外，口腔护理组在VAP发生前在ICU的住院时间比非口腔护理组长（8.5 +/- 4.6 vs 6.3 +/- 7.5天）。然而，两组之间的机械通气持续时间或住院时间均无显著差异（分别为5.9 +/- 0.8 vs 6.0 +/- 8.8天和7.5 +/- 11.5 vs 7.2 +/- 9.5天）。铜绿假单胞菌是两组中最常见的细菌。结论：口腔护理可降低ICU患者呼吸机相关性肺炎的发生率。
Objective:To examine whether oral care contributes to preventing ventilator-associated pneumonia (VAP) in ICU patients.Design:Nonrandomized trial with historical controls.Setting:A medical-surgical ICU in a university hospital.Patients:1,666 mechanically ventilated patients admitted to the ICU.Intervention:Oral care was provided to 1,252 patients who were admitted to the ICU during period between January 1997 and December 2002 (oral care group), while 414 patients who were admitted to the ICU during period between January1995 and December 1996 and who did not receive oral care served as historical controls (non-oral care group).Measurements and results:Incidence of VAP(episodes of pneumonia per 1000 ventilator days) in the oral care group was significantly lower than that in the non-oral care group (3.9 vs 10.4). The relative risk of VAP in the oral care group compared to that in the non-oral care group was 0.37, with an attributable risk of -3.96%. Furthermore, length of stay in ICU before onset of VAP was greater in the oral care than in the non-oral care group (8.5 +/- 4.6 vs 6.3 +/- 7.5 days). However, no significant difference was observed in either duration of mechanical ventilation or length of stay between the groups (5.9 +/- 0.8 vs 6.0 +/- 8.8 days and 7.5 +/- 11.5 vs 7.2 +/- 9.5 days, respectively). Pseudomonoas aeruginosa was the most frequently detected bacteria in both groups. Number of potentially pathogenic bacteria in oral cavity was significantly reduced by single oral care procedure.Conclusion:Oral care decreased the incidence of VAP in ICU patients.Descriptor:Pulmonary nosocomial infection.