title: The effect of oral care on intracranial pressure in critically ill adults.
abstract: A major goal in the care of patients with neurological problems is to prevent or minimize episodes of increased intracranial pressure (ICP). Elevations in ICP in response to nursing interventions have been acknowledged since the 1960s when ICP monitoring was first introduced in the clinical setting. Until recently, few studies have specifically examined the effect of oral care on ICP, and oral care and other hygiene measures were combined or not specified, prohibiting a direct interpretation of the influence of oral care alone on ICP. The purpose of this study was to describe the relationship between routine oral care interventions and the changes in ICP specifically focusing on the effect of intensity and duration of this intervention. Twenty-three patients with a clinical condition requiring ICP monitoring were enrolled over a 12-month period. Oral care provided by neuroscience intensive care nurses was observed and videotaped. Characteristics of the intervention were documented including products used, patient positioning, and duration of the intervention. A 1-5 subjective scale was used to score intensity of oral care. Wrist actigraphy data were collected from the nurses to provide an objective measure of intensity. Patient physiologic data were collected at 12-second epochs 5 minutes before, during, and 5 minutes after oral care. The mixed-effect repeated measures analysis of variance model indicated that there was a statistically significant increase in ICP in response to oral care (p = .0031). There was, however, no clinically significant effect on ICP. This study provides evidence that oral care is safe to perform in patients in the absence of preexisting elevated ICP.
authors.affiliation: Mary Jo Grap, PhD RN FAAN, is Professor, Adult Health and Nursing Systems, Virginia Commonwealth University School of Nursing, Richmond, VA. Cindy L. Munro, PhD RN ANP-BC FAAN, is Associate Dean for Research and Innovation, Professor, University of South Florida College of Nursing, Tampa, FL. Angela Starkweather, PhD RN, is Associate Professor and Chair, Department of Adult Health and Nursing Systems Department Chair, Virginia Commonwealth University School of Nursing, Richmond, VA. Randall E. Merchant, PhD, is Professor, Department of Anatomy and Neurophysiology, and Affiliate Professor, Department of Anatomy and Neurobiology, Virginia Commonwealth University School of Medicine, Richmond, VA. The authors declare no conflicts of interest.
authors.forename: Christina M
authors.initials: CM
authors.lastname: Szabo
authors.forename: Mary Jo
authors.initials: MJ
authors.lastname: Grap
authors.forename: Cindy L
authors.initials: CL
authors.lastname: Munro
authors.forename: Angela
authors.initials: A
authors.lastname: Starkweather
authors.forename: Randall E
authors.initials: RE
authors.lastname: Merchant
mesh_terms: D056044:Actigraphy / Q000451:nursing; D000293:Adolescent; D000328:Adult; D000368:Aged; D064648:Critical Care Nursing / Q000379:methods*; D005260:Female; D006801:Humans; D019586:Intracranial Hypertension / Q000451:nursing* / Q000503:physiopathology* / Q000517:prevention & control; D007427:Intracranial Pressure / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D065816:Neuroscience Nursing; D009910:Oral Hygiene / Q000145:classification / Q000451:nursing*; D055815:Young Adult