The impact of tooth brushing versus tooth brushing and chlorhexidine application to avoid postoperative pneumonia in children

Relationships Between Oral Microecosystem and Respiratory Diseases

Oral microecosystem is a very complicated ecosystem that is located in the mouth and comprises oral microbiome, diverse anatomic structures of oral cavity, saliva and interactions between oral microbiota and between oral microbiota and the host. More and more evidence from studies of epidemiology, microbiology and molecular biology is establishing a significant link between oral microecosystem and respiratory diseases. Microbiota settling down in oral microecosystem is known as the main source of lung microbiome and has been associated with the occurrence and development of respiratory diseases like pneumonia, chronic obstructive pulmonary disease, lung cancer, cystic fibrosis lung disease and asthma. In fact, it is not only indigenous oral microbes promote or directly cause respiratory infection and inflammation when inhaled into the lower respiratory tract, but also internal environment of oral microecosystem serves as a reservoir for opportunistic respiratory pathogens. Moreover, poor oral health and oral diseases caused by oral microecological dysbiosis (especially periodontal disease) are related with risk of multiple respiratory diseases. Here, we review the research status on the respiratory diseases related with oral microecosystem. Potential mechanisms on how respiratory pathogens colonize oral microecosystem and the role of indigenous oral microbes in pathogenesis of respiratory diseases are also summarized and analyzed. Given the importance of oral plaque control and oral health interventions in controlling or preventing respiratory infection and diseases, we also summarize the oral health management measures and attentions, not only for populations susceptible to respiratory infection like the elderly and hospitalized patients, but also for dentist or oral hygienists who undertake oral health care. In conclusion, the relationship between respiratory diseases and oral microecosystem has been established and supported by growing body of literature. However, etiological evidence on the role of oral microecosystem in the development of respiratory diseases is still insufficient. Further detailed studies focusing on specific mechanisms on how oral microecosystem participate in the pathogenesis of respiratory diseases could be helpful to prevent and treat respiratory diseases.

Risk Assessment for Postoperative Pneumonia in Children Living With Neurologic Impairments

BACKGROUND

Approximately one-third of all pediatric hospital charges are attributable to the care for children living with neurologic comorbidities. These children often require various surgical procedures and may have an elevated risk of lower respiratory infections because of poor neuromuscular coordination, poor cough, uncoordinated swallowing, and poor oral hygiene. Our objective was to evaluate the risk of pneumonia in children presenting with neurologic comorbidities.

METHODS

We performed a retrospective study of children (<18 years) who underwent inpatient surgery between 2012 and 2018 in hospitals participating in the National Surgical Quality Improvement Program. Our primary outcome was the time to incident pneumonia within the 30 days after surgery.

RESULTS

We identified 349 163 children, of whom 2191 developed pneumonia (30-day cumulative incidence: 0.6%). The presence of a preoperative neurologic comorbidity conferred approximately twofold higher risk of postoperative pneumonia (hazard ratio [HR]: 1.91, 95% confidence interval [CI]: 1.73-2.11). We explored the risk of pneumonia conferred by the components of neurologic comorbidity: cerebral palsy (HR: 3.92, 95% CI: 3.38-4.56), seizure disorder (HR: 2.93, 95% CI: 2.60-3.30), neuromuscular disorder (HR: 2.63, 95% CI: 2.32-2.99). The presence of a neurologic comorbidity was associated with a longer length of hospital stay (incidence rate ratio: 1.26, 95% CI: 1.25-1.28).

CONCLUSIONS

The risk of postoperative pneumonia was almost twofold higher in children with neurologic comorbidity. The magnitude of these associations underscores the need to identify areas of research and preventive strategies to reduce the excess risk of pneumonia in children with preoperative neurologic conditions.

Network meta-analysis from a pairwise meta-analysis design: to assess the comparative effectiveness of oral care interventions in preventing ventilator-associated pneumonia in critically ill patients

OBJECTIVE

In this research, we assessed the usefulness of network meta-analysis (NMA), in creating a hierarchy to define the most effective oral care intervention for the prevention and management of ventilation-associated pneumonia (VAP).

MATERIALS AND METHODS

We applied NMA to a previously published robust pairwise meta-analysis. Statistical analyses were based on comparing rates of total VAP events between intervention groups and placebo-usual care groups. We synthesized a netgraph, reported the ranking order of the interventions, and summarized output by a forest plot with a reference treatment placebo/usual care.

RESULTS

The results of this NMA are from the low and high risk of bias studies, and hence, we strongly recommend not to use findings of this NMA for clinical treatment needs, but based on results of the NMA, we highly recommend for future clinical trials. With our inclusion and exclusion criteria for the NMA, we extracted 25 studies (4473 subjects). The NMA included 16 treatments, 29 pairwise comparisons, and 15 designs. Based on results of NMA frequentist-ranking P scores, tooth brushing (P fixed-0.94, P random-0.89), tooth brushing with povidone-iodine (P fixed-0.90, P random-0.88), and furacillin (P fixed-0.88, P random-0.84) were the best three interventions for preventing VAP.

CONCLUSIONS

Any conclusion drawn from this NMA should be taken with caution and recommend future clinical trials with the results.

CLINICAL RELEVANCE

NMA appeared to be an effective platform from which multiple interventions reported in disparate clinical trials could be compared to derive a hierarchical assessment of efficacy in VAP intervention.