Effects of oral care with glutamine in preventing ventilator-associated pneumonia in neurosurgical intensive care unit patients

Oral Care and Positioning to Prevent Ventilator-Associated Pneumonia: A Systematic Review

Introduction

Ventilator-associated pneumonia (VAP) is one of the most common nosocomial infections in critical patients. The negative impacts of VAP on patient outcomes emphasize the importance of effective preventive measures such as oral care and patient positioning. The aim of this review was to investigate the impact of oral care and positioning on the prevention of VAP among patients in the intensive care unit.

Methods

This review was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive search was performed. The methodological quality of included studies was appraised using Joanna Briggs Institute checklists.

Results

In total 13 studies were included, all of them were randomized controlled trials. Six out of nine studies about oral care have significant results on VAP incidence. Regarding the position, Patients positioned at a 45-degree were less likely to develop VAP than those positioned at a 30-degree and those in a supine position.

Conclusion

Although patients positioned at 45-degree angle were less likely to develop VAP than those at 30-degree, it is necessary to individualize this practice before recommending it, once there are some contraindications, such as neurocritical patients. Regarding oral care to prevent VAP, considering the current guidelines' recommendation not to use oral chlorexidine, further studies evaluating alternatives are needed.

Effects of Micronutrients or Conditional Amino Acids on COVID-19-Related Outcomes: An Evidence Analysis Center Scoping Review

Recent narrative reviews have described the potential efficacy of providing individuals infected with coronavirus disease 2019 (COVID-19) with additional micronutrients to reduce disease severity. Although there are compelling reasons why providing additional micronutrients or conditional amino acids may affect COVID-19-related outcomes, evidence is lacking. The objective of this scoping review is to explore and describe the literature examining the effect of providing additional micronutrients or conditional amino acids (glutamine, arginine) in adults with conditions or infections similar to COVID-19 infection on COVID-19-related health outcomes. A literature search of the MEDLINE database and hand search of Cochrane Database of systematic reviews retrieved 1,423 unique studies, and 8 studies were included in this scoping review. Four studies examined a target population with ventilator-related pneumonia and acute respiratory distress syndrome, and the other 4 studies included patients who were at risk for ventilator-associated pneumonia. Interventions included intravenous ascorbic acid, intramuscular cholecalciferol, enteral and intramuscular vitamin E, enteral zinc sulfate, and oral and parenteral glutamine. In 6 of the 8 included studies, baseline status of the nutrient of interest was not reported and, thus, it is uncertain how outcomes may vary in the context of nutrient deficiency or insufficiency compared with sufficiency. In the absence of direct evidence examining efficacy of providing additional micronutrients or conditional amino acids to standard care, registered dietitian nutritionists must rely on clinical expertise and indirect evidence to guide medical nutrition therapy for patients infected with COVID-19.

Effect of Oral Care Program on Prevention of Ventilator-associated Pneumonia in Intensive Care Unit Patients: A Randomized Controlled Trial

Background:

Ventilator-associated pneumonia (VAP) is one of the most common nosocomial infections that increase mortality rate and the length of hospitalization. Oral care can improve patient's oral health, however, the role of oral care in the reduction in incidence rate of VAP is indisputable. The aim of this study was to investigate the effect of oral care on the frequency of VAP of patients in intensive care unit.

Materials and Methods:

This clinical trial was conducted on 80 participants who were randomly assigned to a control group and an intervention group from 2016 to 2017. Data were collected at the first, third, and fifth days of the study using a demographic and clinical characteristics questionnaire and the Clinical Pulmonary Infection Score for detecting pneumonia. Data analysis was performed using descriptive and inferential statistics in SPSS software.

Results:

The results of this study showed that the frequency of pneumonia on the third and fifth days was 15.80% (6) and 23.70% (9) in the control group and 10.50% (4) and 7.90% (3) in the intervention group, respectively. Chi-square test did not show a significant difference (p = 0.059); however, the frequency of pneumonia in the intervention group reduced compared with the control group.

Conclusions:

According to the results of this study, the oral care program could not significantly decrease the incidence of VAP in critically ill patients compared with routine oral care practices. Similar studies with a larger sample size and longer duration should be conducted for better results.