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Scannapieco FA. Poor Oral Health in the Etiology and Prevention of Aspiration Pneumonia. Clin Geriatr Med 2023; 39:257-271. [PMID: 37045532 DOI: 10.1016/j.cger.2023.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
Aspiration pneumonia (AP), inflammation of the lung parenchyma initiated by aspirated microorganisms into the lower airways from proximal sites, including the oral cavity, is prevalent in, and problematic for, the elderly, especially those in institutions, and for those with several important risk factors. Many factors influence the pathogenesis of AP, including dysphagia, poor oral hygiene, diminished host defense, and underlying medical conditions. This article reviews the epidemiology, microbiology, pathogenesis, and prevention of AP, focusing on the role of poor oral health as a risk factor for, and on dental care for the prevention and management of, this important infection.
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Affiliation(s)
- Frank A Scannapieco
- Department of Oral Biology, School of Dental Medicine, University at Buffalo, The State University of New York, Foster Hall, 3435 Main Street, Buffalo, NY 14214, USA.
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2
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Cagle LA, Hopper K, Epstein SE. Complications associated with long-term positive-pressure ventilation in dogs and cats: 67 cases. J Vet Emerg Crit Care (San Antonio) 2022; 32:376-385. [PMID: 35001482 DOI: 10.1111/vec.13177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 11/04/2020] [Accepted: 12/16/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To determine the complications associated with positive-pressure ventilation (PPV) in dogs and cats. DESIGN Retrospective study from October 2009 to September 2013. SETTING University Teaching Hospital. ANIMALS Fifty-eight dogs and 9 cats. MEASUREMENTS AND MAIN RESULTS Medical records were retrospectively reviewed; signalment, complications associated with PPV, duration of PPV, and outcome were recorded. Complications most commonly recorded during PPV included hypothermia 41/67 (61%), hypotension 39/67 (58%), cardiac arrhythmias 33/67 (49%), a positive fluid balance 31/67 (46%), oral lesions 25/67 (37%), and corneal ulcerations 24/67 (36%). A definition of ventilator-associated events (VAE) extrapolated from the Center of Disease Control's criteria was applied to 21 cases that received PPV for at least 4 days in this study. Ventilator-associated conditions occurred in 5 of 21 (24%) of cases with infection-related ventilator-associated conditions and ventilator-associated pneumonia identified in 3 of 21 (14%) cases. CONCLUSIONS Complications are common and diverse in dogs and cats receiving long-term PPV and emphasizes the importance of intensive, continuous patient monitoring and appropriate nursing care protocols. Many of the complications identified could be serious without intervention and suggests that appropriate equipment alarms could improve patient safety. Development of veterinary specific surveillance tools such as the VAE criteria would aid future investigations and allow for effective multicenter studies.
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Affiliation(s)
- Laura A Cagle
- William R. Pritchard Veterinary Medical Teaching Hospital, University of California Davis, Davis, California, USA
| | - Kate Hopper
- Department of Veterinary Surgical and Radiological Sciences, School of Veterinary Medicine, University of California Davis, Davis, California, USA
| | - Steven E Epstein
- Department of Veterinary Surgical and Radiological Sciences, School of Veterinary Medicine, University of California Davis, Davis, California, USA
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Jun MK, Ku JK, Kim IH, Park SY, Hong J, Kim JY, Lee JK. Hospital Dentistry for Intensive Care Unit Patients: A Comprehensive Review. J Clin Med 2021; 10:jcm10163681. [PMID: 34441976 PMCID: PMC8397125 DOI: 10.3390/jcm10163681] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 07/31/2021] [Accepted: 08/18/2021] [Indexed: 11/16/2022] Open
Abstract
This study aimed to review the oral hygiene status, oral care guidelines, and outcomes of oral care in intensive care unit (ICU) patients from a dental perspective for effective oral care. A literature search using the keywords "Hospital dentistry" OR "Oral care" OR "Intensive care unit" OR "Hospital inpatient" OR "Hospitalization" OR "Emergency service" AND "Oral health" OR "Oral hygiene" OR "Dental plaque" was conducted in PubMed, Medline, and Google Scholar to identify publications reporting on the oral care of the patients admitted to ICUs. A total of 17,400 articles were initially identified. Of these, 58 were selected and classified into three categories for critical review. Seven of these studies evaluated the oral status of ICU patients, and most of the studies indicated that ICU patients had poor oral hygiene or required active dental treatment. Thirty-three of these studies evaluated oral care methods for ICU patients, and in general, oral care methods using chlorhexidine as adjuncts along with tooth brushing were recommended. However, there were insufficient studies to evaluate oral hygiene through effective assessment tools from a dental perspective. In 36 studies on the outcomes of oral care in ICU patients, interventions by dental professionals showed effective results in preventing hospital-acquired infection. This review highlights the importance of establishing guidelines for the evaluation of oral status in ICU patients and summarizes data that may be useful for future studies. Further studies on maintaining good oral hygiene among ICU patients are needed.
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Affiliation(s)
- Mi-Kyoung Jun
- Department of Oral and Maxillofacial Surgery, Institute of Oral Health Science, Ajou University School of Medicine, Suwon 16499, Korea;
| | - Jeong-Kui Ku
- Department of Oral and Maxillofacial Surgery, Gangnam Severance Hospital, Yonsei University College of Dentistry, Seoul 06273, Korea; (J.-K.K.); (J.-Y.K.)
| | - Il-hyung Kim
- Department of Oral and Maxillofacial Surgery, Armed Forces Capital Dental Hospital, Armed Forces Medical Command, Seongnam 13574, Korea; (I.-h.K.); (S.-Y.P.)
| | - Sang-Yoon Park
- Department of Oral and Maxillofacial Surgery, Armed Forces Capital Dental Hospital, Armed Forces Medical Command, Seongnam 13574, Korea; (I.-h.K.); (S.-Y.P.)
| | - Jinson Hong
- Department of Prosthodontics, Armed Forces Capital Dental Hospital, Armed Forces Medical Command, Seongnam 13574, Korea;
| | - Jae-Young Kim
- Department of Oral and Maxillofacial Surgery, Gangnam Severance Hospital, Yonsei University College of Dentistry, Seoul 06273, Korea; (J.-K.K.); (J.-Y.K.)
| | - Jeong-Keun Lee
- Department of Oral and Maxillofacial Surgery, Institute of Oral Health Science, Ajou University School of Medicine, Suwon 16499, Korea;
- Correspondence: ; Tel.: +82-31-219-5333; Fax: +82-31-219-5329
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Smith MJ, Lee J, Brodsky AL, Figueroa MA, Stamm MH, Giard A, Luker N, Friedman S, Huncke T, Jain SK, Pothuri B. Optimizing Robotic Hysterectomy for the Patient Who Is Morbidly Obese with a Surgical Safety Pathway. J Minim Invasive Gynecol 2021; 28:2052-2059.e3. [PMID: 34139329 DOI: 10.1016/j.jmig.2021.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 05/24/2021] [Accepted: 06/09/2021] [Indexed: 01/04/2023]
Abstract
STUDY OBJECTIVE Obesity is a growing worldwide epidemic, and patients classified as obese undergoing gynecologic robotic surgery are at increased risk for surgical complications. This study aimed to evaluate the feasibility and outcomes of a surgical safety protocol known as the High BMI [Body Mass Index] Pathway (HBP) for patients with BMI ≥40 kg/m2 undergoing planned robotic hysterectomy. Our primary outcome was the rate of all-cause perioperative complications in patients undergoing surgery with the use of the HBP. DESIGN A retrospective cohort study. SETTING An academic teaching hospital. PATIENTS A total of 138 patients classified as morbidly obese (BMI ≥40 kg/m2) undergoing robotic hysterectomy. INTERVENTIONS The HBP was developed by a multidisciplinary team and was instituted on January 1, 2016, as a quality improvement project. Patients classified as morbidly obese undergoing robotic hysterectomy after this date were compared with consecutive historical controls. MEASUREMENTS AND MAIN RESULTS Seventy-two patients underwent robotic hysterectomies on the HBP and were compared with 66 controls. There were no differences in age, BMI, blood loss, number of comorbidities, or cancer diagnosis. Since the implementation of the HBP, there has been a decrease in anesthesia time (-57.0 minutes; p = .001) and total operating room time (-47.0 min; p = .020), as well as lower estimated blood loss (median 150 mL [interquartile range 100-200] vs 200 mL [interquartile range 100-300]; p = .002) and reduction in overnight hospital admissions (33.3% vs 63.6%; p <.001). In the HBP group, there were fewer all-cause complications (19.4% vs 37.9%; p = .023) and infectious complications (8.3% vs 33.3%; p = .001), and there was no increase in the readmission rates (p = .400). In multivariable analysis, the HBP reduced all-cause complications (odds ratio 0.353; p = .010) after controlling for the covariate (total time in the operating room). CONCLUSION The HBP is a feasible method of optimizing the outcome for patients classified as morbidly obese undergoing major gynecologic surgery. Initiation of the HBP can lead to decreased anesthesia and operating times, all-cause complications, and overnight hospital admissions without increasing readmission rates.
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Affiliation(s)
- Maria J Smith
- Department of Obstetrics and Gynecology, NYU Langone Health (Dr. Smith), New York, NY
| | - Jessica Lee
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Texas Southwestern Medical Center (Drs. Lee), Dallas, TX
| | - Allison L Brodsky
- Department of Obstetrics and Gynecology, University of California San Diego (Drs. Brodsky), San Diego, CA
| | - Melissa A Figueroa
- NYU Medical Center, NYU Langone Health (Mss. Figueroa, Giard, and Luker, and Mr. Stamm)
| | - Matthew H Stamm
- NYU Medical Center, NYU Langone Health (Mss. Figueroa, Giard, and Luker, and Mr. Stamm)
| | - Audra Giard
- NYU Medical Center, NYU Langone Health (Mss. Figueroa, Giard, and Luker, and Mr. Stamm)
| | - Nadia Luker
- NYU Medical Center, NYU Langone Health (Mss. Figueroa, Giard, and Luker, and Mr. Stamm)
| | - Steven Friedman
- Department of Population Health, NYU Langone Health (Mr. Friedman)
| | - Tessa Huncke
- Department of Anesthesiology, NYU Langone Health (Drs. Huncke and Jain), New York, NY
| | - Sudheer K Jain
- Department of Anesthesiology, NYU Langone Health (Drs. Huncke and Jain), New York, NY
| | - Bhavana Pothuri
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, NYU Langone Health (Dr. Pothuri).
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Scannapieco FA. Poor Oral Health in the Etiology and Prevention of Aspiration Pneumonia. Dent Clin North Am 2021; 65:307-321. [PMID: 33641755 DOI: 10.1016/j.cden.2020.11.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Aspiration pneumonia (AP), inflammation of the lung parenchyma initiated by aspirated microorganisms into the lower airways from proximal sites, including the oral cavity, is prevalent in, and problematic for, the elderly, especially those in institutions, and for those with several important risk factors. Many factors influence the pathogenesis of AP, including dysphagia, poor oral hygiene, diminished host defense, and underlying medical conditions. This article reviews the epidemiology, microbiology, pathogenesis, and prevention of AP, focusing on the role of poor oral health as a risk factor for, and on dental care for the prevention and management of, this important infection.
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Affiliation(s)
- Frank A Scannapieco
- Department of Oral Biology, School of Dental Medicine, University at Buffalo, The State University of New York, Foster Hall, 3435 Main Street, Buffalo, NY 14214, USA.
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Yu XR, Xu N, Huang ST, Zhang QL, Wang ZC, Cao H, Chen Q. Effects of different oral care strategies on postoperative pneumonia in infants with mechanical ventilation after cardiac surgery: a prospective randomized controlled study. Transl Pediatr 2021; 10:359-365. [PMID: 33708522 PMCID: PMC7944187 DOI: 10.21037/tp-20-295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND To explore the effects of different oral care strategies on postoperative pneumonia in infants with mechanical ventilation after cardiac surgery. METHODS A prospective randomized controlled study was conducted at a hospital in Fujian Province, China. Participants were randomly divided into the breast milk oral care group, physiological saline oral care group, and sodium bicarbonate oral care group to explore the effects of different oral care strategies on postoperative pneumonia in infants on mechanical ventilation cardiac surgery. RESULTS The mechanical ventilation duration, the hospitalization costs, and the length of intensive care unit (ICU) stay and postoperative hospital stay in the breast milk oral care group were significantly shorter than those in the physiological saline oral care group and the sodium bicarbonate oral care group. The incidence of postoperative pneumonia in the breast milk oral care group was 3.2%, which was significantly lower than that in the physiological saline oral care group (22.6%) and the sodium bicarbonate oral care group (19.4%). CONCLUSIONS Using breast milk for oral care in infants after cardiac surgery has a lower incidence of postoperative pneumonia than traditional oral care strategies of physiological saline and sodium bicarbonate, and it is worthy of clinical application.
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Affiliation(s)
- Xian-Rong Yu
- Department of Cardiac Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou, China
| | - Ning Xu
- Department of Cardiac Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou, China
| | - Shu-Ting Huang
- Department of Cardiac Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou, China
| | - Qi-Liang Zhang
- Department of Cardiac Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou, China
| | - Zeng-Chun Wang
- Department of Cardiac Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou, China.,Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, Chin
| | - Hua Cao
- Department of Cardiac Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou, China
| | - Qiang Chen
- Department of Cardiac Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou, China.,Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, Chin
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Silva PUJ, Paranhos LR, Meneses-Santos D, Blumenberg C, Macedo DR, Cardoso SV. Combination of toothbrushing and chlorhexidine compared with exclusive use of chlorhexidine to reduce the risk of ventilator-associated pneumonia: A systematic review with meta-analysis. Clinics (Sao Paulo) 2021; 76:e2659. [PMID: 34133659 PMCID: PMC8158674 DOI: 10.6061/clinics/2021/e2659] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 04/15/2021] [Indexed: 01/08/2023] Open
Abstract
This study aimed to compare the effectiveness of 0.12% chlorhexidine alone and 0.12% chlorhexidine in combination with toothbrushing to prevent ventilator-associated pneumonia (VAP) in mechanically ventilated patients. The Embase, Latin American and Caribbean Health Science Literature, PubMed, Scientific Electronic Library Online, Scopus, LIVIVO, Web of Science, Cochrane Library, OpenThesis, and Open Access Thesis and Dissertations databases were used. Only randomized controlled trials without restrictions on the year or language of publication were included. Two reviewers assessed the risk of bias using the Joanna Briggs Institute Critical Appraisal Tool. A meta-analysis using a random-effects model estimated the combined relative risk (RR). The Grading of Recommendations, Assessment, Development and Evaluations approach was used to assess the certainty of the evidence. Initially, 2,337 studies were identified, of which 4 were considered in the systematic review and 3 in the meta-analysis (total sample: 796 patients). The studies were published between 2009 and 2017. All eligible studies had a low risk of bias. The meta-analysis revealed that the risk of VAP was 24% lower in patients receiving chlorhexidine combined with toothbrushing than in those receiving chlorhexidine alone (RR: 0.76; 95% confidence interval: 0.55-1.06), with moderate certainty of evidence and without statistical significance. In conclusion, considering the limitations of this study, a standard protocol for the prevention of VAP is not yet recommended. More studies with larger sample sizes are needed to draw strong conclusions. However, considering that toothbrushing is a simple intervention, it should be a common practice in mechanically ventilated patients, especially among patients with coronavirus disease.
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Affiliation(s)
- Pedro Urquiza Jayme Silva
- Programa de Pos-Graduacao em Odontologia, Faculdade de Odontologia, Universidade Federal de Uberlandia, Uberlandia, MG, BR
| | - Luiz Renato Paranhos
- Area de Odontologia Preventiva e Social, Faculdade de Odontologia, Universidade Federal de Uberlandia, Uberlandia, MG, BR
- Corresponding author. E-mail:
| | - Daniela Meneses-Santos
- Programa de Residencia em Cirurgia e Traumatologia Buco-Maxilo-Facial, Faculdade de Medicina, Universidade Federal de Uberlandia, Uberlandia, MG, BR
| | - Cauane Blumenberg
- Programa de Pos-Graduacao em Epidemiologia, Faculdade de Medicina, Universidade Federal de Pelotas, Pelotas, RS, BR
| | | | - Sérgio Vitorino Cardoso
- Area de Patologia, Faculdade de Odontologia, Universidade Federal de Uberlandia, Uberlandia, MG, BR
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Zhang P, Xia G, Dai L, Cheng Y, Wang Z. Laryngoscope-assisted and cotton ball wiping methods in prevention of oral and pulmonary infection in patients receiving mechanical ventilation and the influence on hypersensitive C-reactive protein and procalcitonin. Exp Ther Med 2019; 18:531-536. [PMID: 31258690 PMCID: PMC6566126 DOI: 10.3892/etm.2019.7614] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 05/06/2019] [Indexed: 12/18/2022] Open
Abstract
Effects of laryngoscope-assisted and cotton ball wiping methods on the prevention of oral and pulmonary infection in patients receiving mechanical ventilation were compared to explore the influence of the two methods on high-sensitivity C-reactive protein (hs-CRP) and procalcitonin (PCT). In total, 152 patients who underwent mechanical ventilation in the ICU of Beijing Jishuitan Hospital from May 2005 to January 2018 were assigned and equally divided into two groups: 76 patients who had their oropharynxes scrubbed and rinsed by an electric toothbrush under direct vision by the use of a laryngoscope were selected as the laryngoscope group, and 76 patients who received the conventional cotton ball wiping method and the flushing method for oropharyngeal cleaning were assigned in the cotton ball group. Detection of serum hs-CRP and PCT levels in a 2-ml sample of fasting venous blood was performed on both groups of patients before hospitalization, and on the 5th and 10th day of hospitalization. The incidence rate of oral infection and ventilator-associated pneumonia, as well as the length of the cleaning time were recorded. The incidence rate of oral infection and ventilator-associated pneumonia in the laryngoscope group was statistically much lower than that in the cotton ball group (P<0.05). Before the experiment, there was no significant difference in the hs-CRP and PCT levels between the two groups (P>0.050), whereas the laryngoscope group had significantly lower hs-CRP and PCT levels at the 5th and 10th day of hospitalization than those in the cotton ball group (P<0.05). The hs-CRP and PCT levels at the three time-points in the same group were statistically different (P<0.05). In conclusion, oropharyngeal scrub and rinse by an electric toothbrush assisted by a laryngoscope, can not only better prevent oral infection and reduce the incidence of ventilator-associated pneumonia, but it also has shorter cleaning time and results in lower levels of inflammatory factors, which make this method beneficial in the clinic.
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Affiliation(s)
- Pingji Zhang
- Department of Respiratory Disease, Beijing Jishuitan Hospital, Beijing 100035, P.R. China
| | - Guoguang Xia
- Department of Respiratory Disease, Beijing Jishuitan Hospital, Beijing 100035, P.R. China
| | - Li Dai
- Department of Respiratory Disease, Beijing Jishuitan Hospital, Beijing 100035, P.R. China
| | - Yang Cheng
- Department of Respiratory Disease, Beijing Jishuitan Hospital, Beijing 100035, P.R. China
| | - Zhuo Wang
- Department of Respiratory Disease, Beijing Jishuitan Hospital, Beijing 100035, P.R. China
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Use of Chlorhexidine to Prevent Ventilator-Associated Pneumonia in a Long-term Care Setting: A Retrospective Medical Record Review. J Nurs Care Qual 2018; 34:263-268. [PMID: 30325851 DOI: 10.1097/ncq.0000000000000367] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND The purpose of this study was to explore the use of the oral decontamination solution chlorhexidine (CHX) to reduce ventilator-associated pneumonia (VAP) in a long-term ventilator care setting over time. Most of the research in this area has been conducted in acute and intensive care settings. METHODS This study was a retrospective medical record review conducted in a long-term care facility with a dedicated ventilator unit. Veterans records (N = 12) were accessed for this study. The study covered 50 months, with a 43-month time period during which CHX was administered. RESULTS While the sample size was small, many of the veterans on ventilators used CHX for years without an incident of VAP. CONCLUSIONS These findings support using CHX to significantly reduce the number of days of intravenous antibiotics used to treat VAP with little side effects.
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10
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Scannapieco FA, Cantos A. Oral inflammation and infection, and chronic medical diseases: implications for the elderly. Periodontol 2000 2018; 72:153-75. [PMID: 27501498 DOI: 10.1111/prd.12129] [Citation(s) in RCA: 172] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2015] [Indexed: 12/12/2022]
Abstract
Oral diseases, such as caries and periodontitis, not only have local effects on the dentition and on tooth-supporting tissues but also may impact a number of systemic conditions. Emerging evidence suggests that poor oral health influences the initiation and/or progression of diseases such as atherosclerosis (with sequelae including myocardial infarction and stoke), diabetes mellitus and neurodegenerative diseases (such as Alzheimer's disease, rheumatoid arthritis and others). Aspiration of oropharyngeal (including periodontal) bacteria causes pneumonia, especially in hospitalized patients and the elderly, and may influence the course of chronic obstructive pulmonary disease. This article addresses several pertinent aspects related to the medical implications of periodontal disease in the elderly. There is moderate evidence that improved oral hygiene may help prevent aspiration pneumonia in high-risk patients. For other medical conditions, because of the absence of well-designed randomized clinical trials in elderly patients, no specific guidance can be provided regarding oral hygiene or periodontal interventions that enhance the medical management of older adults.
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Zand F, Zahed L, Mansouri P, Dehghanrad F, Bahrani M, Ghorbani M. The effects of oral rinse with 0.2% and 2% chlorhexidine on oropharyngeal colonization and ventilator associated pneumonia in adults' intensive care units. J Crit Care 2017; 40:318-322. [PMID: 28320561 DOI: 10.1016/j.jcrc.2017.02.029] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 01/08/2017] [Accepted: 02/19/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Ventilator Associated Pneumonia (VAP) is the most common nosocomial infection in Intensive Care Units (ICUs) which increases the length of ICU stay, duration of mechanical ventilation, and mortality. The present study used an oral care protocol and compared the effects of two different concentrations of chlorhexidine on reduction of oropharyngeal colonization and VAP. MATERIALS AND METHODS This study was performed on 114 patients from trauma, surgery, neurosurgery, and general ICUs randomly allocated to two groups under oral care with 0.2% and 2% chlorhexidine solution. A multidisciplinary team approved the oral care protocol. Data was collected using a demographic information form, APACHE IV form, Beck oral assessment scale, mucosal-plaque assessment scale, and oropharyngeal swab culture. RESULTS The results showed a significant reduction in VAP (p=0.007) and oropharyngeal colonization (p=0.007) in the group under oral care with 2% chlorhexidine solution compared with the other group. However, no significant difference was found between the two groups in terms of oropharyngeal adverse effects (p=0.361). CONCLUSION Oral decontamination with 2% compared to 0.2% chlorhexidine is a more effective method in the prevention of VAP and reduction of oropharyngeal colonization (especially gram-positive).
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Affiliation(s)
- Farid Zand
- Shiraz Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Leili Zahed
- Fatemeh Nursing and Midwifery School, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Parisa Mansouri
- Fatemeh Nursing and Midwifery School, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Freshte Dehghanrad
- Fatemeh Nursing and Midwifery School, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maryam Bahrani
- Shiraz Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Ghorbani
- Shiraz Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Implementing the Free Water Protocol does not Result in Aspiration Pneumonia in Carefully Selected Patients with Dysphagia: A Systematic Review. Dysphagia 2016; 32:345-361. [DOI: 10.1007/s00455-016-9761-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 11/08/2016] [Indexed: 10/20/2022]
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Abstract
The management of acute respiratory failure varies according to the etiology. A clear understanding of physiology of respiration and pathophysiological mechanisms of respiratory failure is mandatory for managing these patients. The extent of abnormality in arterial blood gas values is a result of the balance between the severity of disease and the degree of compensation by cardiopulmonary system. Normal blood gases do not mean that there is an absence of disease because the homeostatic system can compensate. However, an abnormal arterial blood gas value reflects uncompensated disease that might be life threatening.
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Infektionsschutz und spezielle Hygienemaßnahmen in klinischen Disziplinen. KRANKENHAUS- UND PRAXISHYGIENE 2016. [PMCID: PMC7152143 DOI: 10.1016/b978-3-437-22312-9.00005-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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15
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Reduced occurrence of ventilator-associated pneumonia after cardiac surgery using preoperative 0.2% chlorhexidine oral rinse: results from a single-centre single-blinded randomized trial. J Hosp Infect 2015; 91:362-6. [DOI: 10.1016/j.jhin.2015.08.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2015] [Accepted: 08/12/2015] [Indexed: 11/23/2022]
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Scannapieco FA, Shay K. Oral health disparities in older adults: oral bacteria, inflammation, and aspiration pneumonia. Dent Clin North Am 2014; 58:771-82. [PMID: 25201541 DOI: 10.1016/j.cden.2014.06.005] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Poor oral hygiene has been suggested to be a risk factor for aspiration pneumonia in the institutionalized and disabled elderly. Control of oral biofilm formation in these populations reduces the numbers of potential respiratory pathogens in the oral secretions, which in turn reduces the risk for pneumonia. Together with other preventive measures, improved oral hygiene helps to control lower respiratory infections in frail elderly hospital and nursing home patients.
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Affiliation(s)
- Frank A Scannapieco
- Department of Oral Biology, School of Dental Medicine, University at Buffalo - The State University of New York, Foster Hall, Buffalo, NY 14214, USA.
| | - Kenneth Shay
- Geriatrics and Extended Care Services (10P4G), US Department of Veterans Affairs, PO Box 134002, Ann Arbor, MI 48113-4002, USA
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Scholes J. What's in this issue? Nurs Crit Care 2014; 18:109-11. [PMID: 23577943 DOI: 10.1111/nicc.12024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
DATA SOURCES PubMed, CINAHL, Cochrane Library, National Guidelines Clearinghouse, Web of Science and Google Scholar databases were searched. STUDY SELECTION Experimental and non-experimental English language studies in adults in hospitalised and non-hospitalised patients were included. DATA EXTRACTION AND SYNTHESIS A qualitative summary of the included studies was presented. RESULTS Seven experimental and three descriptive studies were included. All of the studies examined toothbrush contamination and found significant bacterial retention and survival on toothbrushes after use. A number of decontamination techniques were studied and a range of active agents reduced bacterial load. Closed storage containers generally increased bacterial load or survival times. Toothbrush design was also seen to have varying impact on bacterial load. CONCLUSIONS The selected studies found that toothbrushes of healthy and oral diseased adults become contaminated with pathogenic bacteria from dental plaque, design, environment or a combination of factors. There are no studies that specifically examine toothbrush contamination and the role of environmental factors, toothbrush contamination, and vulnerable populations in the hospital setting (eg critically ill adults) and toothbrush use in nursing clinical practice.
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Dale C, Angus JE, Sinuff T, Mykhalovskiy E. Mouth care for orally intubated patients: a critical ethnographic review of the nursing literature. Intensive Crit Care Nurs 2012; 29:266-74. [PMID: 23092851 DOI: 10.1016/j.iccn.2012.09.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Revised: 09/11/2012] [Accepted: 09/22/2012] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aim of this critical ethnographic literature review was to explore the evolution of nursing discourse in oral hygiene for intubated and mechanically ventilated patients. METHODS The online databases CINAHL and MEDLINE were searched for nurse-authored English language articles published between 1960 and 2011 in peer-reviewed journals. Articles that did not discuss oral problems or related care for intubated adult patients were excluded. Articles that met the inclusion criteria were chronologically reviewed to trace changes in language and focus over time. RESULTS A total of 469 articles were identified, and 84 papers met all of the inclusion criteria. These articles presented an increasingly scientific and evaluative nursing discourse. Oral care originally focused on patient comfort within the literature; now it is emphasized as an infection control practice for the prevention of ventilator-associated pneumonia (VAP). Despite concern for its neglected application, the literature does not sufficiently address mouth care's practical accomplishment. CONCLUSIONS Mouth care for orally intubated patients is both a science and practice. However, the nursing literature now emphasises a scientific discourse of infection prevention. Inattention to the social and technical complexities of practice may inhibit how nurses learn, discuss and effectively perform this critical aspect of patient care.
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Affiliation(s)
- Craig Dale
- Trauma, Emergency and Critical Care Program, Sunnybrook Health Sciences Centre, B508 - 2075 Bayview Avenue, Toronto, Ontario, Canada M4N 3M5.
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Gupta D, Agarwal R, Aggarwal AN, Singh N, Mishra N, Khilnani GC, Samaria JK, Gaur SN, Jindal SK. Guidelines for diagnosis and management of community- and hospital-acquired pneumonia in adults: Joint ICS/NCCP(I) recommendations. Lung India 2012; 29:S27-62. [PMID: 23019384 PMCID: PMC3458782 DOI: 10.4103/0970-2113.99248] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Dheeraj Gupta
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ritesh Agarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ashutosh Nath Aggarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Navneet Singh
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Narayan Mishra
- Department of Pulmonary Medicine, Indian Chest Society, India
| | - G. C. Khilnani
- Department of Pulmonary Medicine, National College of Chest Physicians, India
| | - J. K. Samaria
- Department of Pulmonary Medicine, Indian Chest Society, India
| | - S. N. Gaur
- Department of Pulmonary Medicine, National College of Chest Physicians, India
| | - S. K. Jindal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - for the Pneumonia Guidelines Working Group
- Pneumonia Guidelines Working Group Collaborators (43) A. K. Janmeja, Chandigarh; Abhishek Goyal, Chandigarh; Aditya Jindal, Chandigarh; Ajay Handa, Bangalore; Aloke G. Ghoshal, Kolkata; Ashish Bhalla, Chandigarh; Bharat Gopal, Delhi; D. Behera, Delhi; D. Dadhwal, Chandigarh; D. J. Christopher, Vellore; Deepak Talwar, Noida; Dhruva Chaudhry, Rohtak; Dipesh Maskey, Chandigarh; George D’Souza, Bangalore; Honey Sawhney, Chandigarh; Inderpal Singh, Chandigarh; Jai Kishan, Chandigarh; K. B. Gupta, Rohtak; Mandeep Garg, Chandigarh; Navneet Sharma, Chandigarh; Nirmal K. Jain, Jaipur; Nusrat Shafiq, Chandigarh; P. Sarat, Chandigarh; Pranab Baruwa, Guwahati; R. S. Bedi, Patiala; Rajendra Prasad, Etawa; Randeep Guleria, Delhi; S. K. Chhabra, Delhi; S. K. Sharma, Delhi; Sabir Mohammed, Bikaner; Sahajal Dhooria, Chandigarh; Samir Malhotra, Chandigarh; Sanjay Jain, Chandigarh; Subhash Varma, Chandigarh; Sunil Sharma, Shimla; Surender Kashyap, Karnal; Surya Kant, Lucknow; U. P. S. Sidhu, Ludhiana; V. Nagarjun Mataru, Chandigarh; Vikas Gautam, Chandigarh; Vikram K. Jain, Jaipur; Vishal Chopra, Patiala; Vishwanath Gella, Chandigarh
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Scholes J. What's in this issue? Nurs Crit Care 2011. [DOI: 10.1111/j.1478-5153.2011.00477.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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