Oral health status and development of ventilator-associated pneumonia: a descriptive study.
BACKGROUND
Ventilator-associated pneumonia is a significant cause of morbidity and mortality and may be influenced by oral health.


OBJECTIVE
To describe the relationship between ventilator-associated pneumonia and oral health status, changes in oral health status during the first 7 days after intubation, and microbial colonization of the oropharynx and trachea.


METHODS
A total of 66 patients were enrolled within 24 hours of intubation and were followed up for up to 7 days. Data on oral health measures and the Clinical Pulmonary Infection Score (CPIS) were collected at baseline, day 4 (n = 37), and day 7 (n = 21). A regression model was used to predict risk of pneumonia at day 4.


RESULTS
Dental plaque and oral organisms increased over time. Correlations were significant for baseline and day 4 dental plaque (P < .001), baseline salivary lactoferrin and day 4 plaque (P = .01), and lower salivary volume and higher day 4 CPIS (P = .02). Potential pathogens were identified in oral cultures for 6 patients before or at the same time as the appearance of the organisms in tracheal aspirates. Correlations were significant with day 4 CPIS for score on the Acute Physiology and Chronic Health Evaluation (APACHE) II (P = .007), day 4 salivary volume (P = .02), interaction of APACHE II score and day 1 CPIS (P<.001), and interaction of day 1 CPIS and plaque (P=.01).


CONCLUSIONS
Higher dental plaque scores confer greater risk for ventilator-associated pneumonia, particularly for patients with greater severity of illness. Salivary volume and lactoferrin may affect the risk.
Munro
Cindy L
CL
Adult Health Department, School of Nursing, Virginia Commonwealth University, Richmond, VA 23298-0567, USA. cmunro@vcu.edu
Grap
Mary Jo
MJ
Elswick
R K
RK
McKinney
Jessica
J
Sessler
Curtis N
CN
Hummel
Russell S
RS
D016638:Critical Illness; D003773:Dental Plaque / Q000382:microbiology*; D005260:Female; D006304:Health Status; D006801:Humans; D007442:Intubation, Intratracheal / Q000009:adverse effects; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009061:Mouth Mucosa / Q000382:microbiology; D009909:Oral Health; D009910:Oral Hygiene; D053717:Pneumonia, Ventilator-Associated / Q000382:microbiology*; D012044:Regression Analysis; D012307:Risk Factors; D012463:Saliva / Q000378:metabolism; D013997:Time Factors