Inadequate salivary flow and poor oral mucosal status in intubated intensive care unit patients.
OBJECTIVE
To investigate salivary flow and frequency of oral mucositis in intensive care unit patients compared with patients admitted because of elective coronary artery bypass graft (CABG) surgery. In addition, the pattern of oropharyngeal colonization was investigated in these patients.


METHODS
Prospective study.


METHODS
Mixed intensive care unit and cardiosurgical ward.


METHODS
In this study, 24 ventilated intensive care unit patients and 20 CABG patients were included.


RESULTS
Two dental hygienists examined intensive care unit patients for the presence of periodontal disease and mucositis at admission and subsequently every week during their stay in the intensive care unit. At the same time, stimulated salivary flow and salivary total immunoglobulin A output were measured. Oropharyngeal cultures were obtained as well. CABG patients were examined the day before the operation, 1 day, 1 wk, and 2 wks after the operation. The following results were obtained: a) temporarily reduced postoperative stimulated salivary flow and total salivary immunoglobulin A output in CABG patients and nearly absent stimulated salivary flow in intensive care unit patients; b) oropharyngeal colonization with potentially pathogenic microorganisms in intensive care unit and not in CABG patients; and c) the increase in mucositis index in intensive care unit patients paralleled the increase in potentially pathogenic microorganism oropharyngeal colonization, especially and.


CONCLUSIONS
Absence of adequate salivary flow in intubated intensive care unit patients causes severe xerostomia, which may contribute to the development of mucositis and oropharyngeal colonization with Gram-negative bacteria.
Dennesen
Paul
P
Department of Medical Microbiology, University Hospital of Maastricht, The Netherlands.
van der Ven
André
A
Vlasveld
Mariel
M
Lokker
Linka
L
Ramsay
Graham
G
Kessels
Alphons
A
van den Keijbus
Petra
P
van Nieuw Amerongen
Arie
A
Veerman
Enno
E
D000328:Adult; D000368:Aged; D001026:Coronary Artery Bypass / Q000009:adverse effects; D004755:Enterobacteriaceae / Q000254:growth & development; D005260:Female; D006090:Gram-Negative Bacteria / Q000254:growth & development; D006801:Humans; D007070:Immunoglobulin A / Q000032:analysis; D007362:Intensive Care Units; D007442:Intubation, Intratracheal / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009910:Oral Hygiene; D009911:Oral Hygiene Index; D009960:Oropharynx / Q000382:microbiology; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D011446:Prospective Studies; D011550:Pseudomonas aeruginosa / Q000254:growth & development; D012463:Saliva / Q000737:chemistry; D012472:Salivation; D012720:Severity of Illness Index; D013211:Staphylococcus aureus / Q000254:growth & development; D013280:Stomatitis / Q000175:diagnosis / Q000209:etiology*; D013997:Time Factors; D014987:Xerostomia / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology
D007070:Immunoglobulin A