Mechanical Ventilation and Cytopathological Changes in the Oral Mucosa

BackgroundThe oral mucosa is an important defense barrier to penetration of microorganisms. Thus, changes in the oral epithelium might indicate risk for infection in intensive care patients receiving mechanical ventilation.ObjectiveTo evaluate the oral mucosa of intensive care patients who did or did not receive mechanical ventilation by using liquid-base exfoliative cytology.MethodsThe sample consisted of 3 groups: 27 patients admitted to intensive care during a 7- to 14-day period who received mechanical ventilation, 29 patients admitted during the same period who did not receive mechanical ventilation, and 27 healthy patients who had no lesions in the mouth. For all 3 groups, samples were collected from the buccal mucosa by using cytology brushes. Smears were applied to glass slides before Papanicolaou staining and were codified for blind analyses by a cytopathologist. Kruskal-Wallis and Dunn tests were used to analyze the results.ResultsPatients receiving mechanical ventilation had higher prevalence and intensity of karyomegaly, perinuclear halos, cell keratinization, deep cells, and leukocyte infiltrates than did patients in the other 2 groups (P < .05). No significant differences were observed between the control group and the group who did not receive mechanical ventilation.ConclusionsLiquid-base exfoliative cytology can be used to detect preclinical alterations in the oral mucosa. Patients treated with mechanical ventilation are vulnerable to infections, and oral care may be valuable in their prognosis.

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Oral Care Interventions and Oropharyngeal Colonization in Children Receiving Mechanical Ventilation

American Journal of Critical Care ◽

10.4037/ajcc2009121 ◽

2009 ◽

Vol 18 (4) ◽

pp. 319-328 ◽

Cited By ~ 31

Author(s):

Mavilde L.G. Pedreira ◽

Denise M. Kusahara ◽

Werther Brunow de Carvalho ◽

Silvia Cristina Núñez ◽

Maria Angélica S. Peterlini

Keyword(s):

Mechanical Ventilation ◽

Intensive Care ◽

Length Of Stay ◽

Oral Care ◽

Ventilatory Support ◽

Critically Ill Children ◽

Controlled Study ◽

Control Group ◽

A Site ◽

Underlying Diseases

Background Recent progress in identification of oral microorganisms has shown that the oropharynx can be a site of origin for dissemination of pathogenic organisms to distant body sites, such as the lungs.Objective To compare the oropharyngeal microbiological profile, duration of mechanical ventilation, and length of stay in the intensive care unit of children receiving mechanical ventilation who had pharmacological or nonpharmacological oral care.Methods A randomized and controlled study was performed in a pediatric intensive unit in São Paulo, Brazil. A total of 56 children were randomly assigned to an experimental group (n=27, 48%) that received oral care with use of 0.12% chlorhexidine digluconate or a control group (n=29, 52%) that received oral care without an antiseptic. Oropharyngeal secretions were collected and cultured on days 0, 2, and 4, and at discharge.Results The 2 groups had similar demographic characteristics, preexisting underlying diseases, and pharmacological, nutritional, and ventilatory support. Gram-negative bacteria were the predominant pathogens: Acinetobacter baumannii, Pseudomonas aeruginosa, Klebsiella pneumoniae, and Enter-obacter species. The 2 groups did not differ significantly in the colonization of normal (P= .72) or pathogenic (P= .62) flora, in the duration of mechanical ventilation (P= .67), or in length of stay in the intensive care (P= .22).Conclusion Use of chlorhexidine combined with nonpharmacological oral care did not decrease the colonization profile, duration of mechanical ventilation, or length of stay in critically ill children receiving mechanical ventilation.

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Systematic Literature Review of Oral Hygiene Practices for Intensive Care Patients Receiving Mechanical Ventilation

American Journal of Critical Care ◽

10.4037/ajcc2007.16.6.552 ◽

2007 ◽

Vol 16 (6) ◽

pp. 552-562 ◽

Cited By ~ 55

Author(s):

Angela M. Berry ◽

Patricia M. Davidson ◽

Janet Masters ◽

Kaye Rolls

Keyword(s):

Mechanical Ventilation ◽

Intensive Care ◽

Randomized Controlled Trials ◽

Oral Hygiene ◽

Oral Care ◽

Controlled Trials ◽

Ventilator Associated Pneumonia ◽

Intensive Care Patients ◽

Randomized Controlled ◽

Hygiene Practices

Background Oropharyngeal colonization with pathogenic organisms contributes to the development of ventilator-associated pneumonia in intensive care units. Although considered basic and potentially nonessential nursing care, oral hygiene has been proposed as a key intervention for reducing ventilator-associated pneumonia. Nevertheless, evidence from randomized controlled trials that could inform best practice is limited. Objective To appraise the peer-reviewed literature to determine the best available evidence for providing oral care to intensive care patients receiving mechanical ventilation and to document a research agenda for this important activity in optimizing patients’ outcomes. Methods Articles published from 1985 to 2006 in English and indexed in the CINAHL, MEDLINE, Joanna Briggs Institute, Cochrane Library, EMBASE, and DARE databases were searched by using the key terms oral hygiene, oral hygiene practices, oral care, mouth care, mouth hygiene, intubated, mechanically ventilated, intensive care, and critical care. Reference lists of retrieved journal articles were searched for publications missed during the primary search. Finally, the Google search engine was used to do a comprehensive search of the World Wide Web to ensure completeness of the search. The search strategy was verified by a health librarian. Results The search yielded 55 articles: 11 prospective controlled trials, 20 observational studies, and 24 descriptive reports. Methodological issues and the heterogeneity of samples precluded meta-analysis. Conclusions Despite the importance of providing oral hygiene to intensive care patients receiving mechanical ventilation, high-level evidence from rigorous randomized controlled trials or high-quality systematic reviews that could inform clinical practice is scarce.

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A Comparison of Methylprednisolone and Dexamethasone in Intensive Care Patients With COVID-19

Journal of Intensive Care Medicine ◽

10.1177/0885066621994057 ◽

2021 ◽

pp. 088506662199405

Author(s):

Justine J. Ko ◽

Clay Wu ◽

Neha Mehta ◽

Noah Wald-Dickler ◽

Wei Yang ◽

...

Keyword(s):

Mechanical Ventilation ◽

Intensive Care ◽

Los Angeles ◽

Usual Care ◽

Low Income ◽

Corticosteroid Treatment ◽

Intensive Care Patients ◽

Institutional Review ◽

Mortality Effect ◽

All Cause Mortality

Objectives: This study retrospectively compares the effectiveness of methylprednisolone to dexamethasone in patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 or COVID-19) requiring intensive care. Design: This is an institutional review board approved cohort study in patients with COVID-19 requiring intensive care unit (ICU) admission. Patients admitted and requiring oxygen supplementation were treated with no steroids, methylprednisolone, or dexamethasone. Setting: This study takes place in the ICU’s at a large, tertiary, public teaching hospital serving a primarily low-income community in urban Los Angeles. Patients: All eligible patients admitted to the ICU for COVID-19 respiratory failure from March 1 to July 31, 2020 were included in this study. Interventions: A total of 262 patients were grouped as receiving usual care (n = 75), methylprednisolone dosed at least at 1mg/kg/day for ≥ 3 days (n = 104), or dexamethasone dosed at least at 6 mg for ≥7 days (n = 83). Measurements and Main Results: All-cause mortality within 50 days of initial corticosteroid treatment as compared to usual care was calculated. The mortality effect was then stratified based on levels of respiratory support received by the patient. In this cohort of 262 patients with severe COVID-19, all-cause mortalities in the usual care, methylprednisolone, and dexamethasone groups were 41.3%, 16.4% and 26.5% at 50 days ( P < 0.01) respectively. In patients requiring mechanical ventilation, mortality was 42% lower in the methylprednisolone group than in the dexamethasone group (hazard ratio 0.48, 95% CI: 0.235-0.956, P = 0.0385). Conclusions: In COVID-19 patients requiring mechanical ventilation, sufficiently dosed methylprednisolone can lead to a further decreased mortality as compared to dexamethasone.

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Sepsis Diagnostics: Intensive Care Scoring Systems Superior to MicroRNA Biomarker Testing

Diagnostics ◽

10.3390/diagnostics10090701 ◽

2020 ◽

Vol 10 (9) ◽

pp. 701

Author(s):

Fabian Link ◽

Knut Krohn ◽

Anna-Maria Burgdorff ◽

Annett Christel ◽

Julia Schumann

Keyword(s):

Intensive Care ◽

Scoring Systems ◽

Digital Pcr ◽

Absolute Quantification ◽

Medical Problem ◽

Control Group ◽

Multiple Parameters ◽

Sepsis Diagnosis ◽

Intensive Care Patients ◽

Healthy Control

Sepsis represents a serious medical problem accounting for numerous deaths of critically ill patients in intensive care units (ICUs). An early, sensitive, and specific diagnosis is considered a key element for improving the outcome of sepsis patients. In addition to classical laboratory markers, ICU scoring systems and serum miRNAs are discussed as potential sepsis biomarkers. In the present prospective observational study, the suitability of miRNAs in sepsis diagnosis was tested based on proper validated and normalized data (i.e., absolute quantification by means of Droplet Digital PCR (ddPCR)) in direct comparison to classical sepsis markers and ICU scores within the same patient cohort. Therefore, blood samples of septic intensive care patients (n = 12) taken at day of admission at ICU were compared to non-septic intensive care patients (n = 12) and a healthy control group (n = 12). Our analysis indicates that all tested biomarkers have only a moderate informative power and do not allow an unequivocal differentiation between septic and non-septic ICU patients. In conclusion, there is no standalone laboratory parameter that enables a reliable diagnosis of sepsis. miRNAs are not superior to classical parameters in this respect. It seems recommendable to measure multiple parameters and scores and to interpret them with regard to the clinical presentation.

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Oral care and nosocomial pneumonia: a systematic review

Einstein (São Paulo) ◽

10.1590/s1679-45082015rw2980 ◽

2015 ◽

Vol 13 (2) ◽

pp. 290-296 ◽

Cited By ~ 12

Author(s):

Maria Carolina Nunes Vilela ◽

Gustavo Zanna Ferreira ◽

Paulo Sérgio da Silva Santos ◽

Nathalie Pepe Medeiros de Rezende

Keyword(s):

Systematic Review ◽

Intensive Care ◽

Intensive Care Units ◽

Nosocomial Pneumonia ◽

Oral Hygiene ◽

Oral Care ◽

Control Group ◽

Level Of Evidence ◽

Grade Of Recommendation ◽

Minimal Bias

To perform a systematic review of the literature on the control of oral biofilms and the incidence of nosocomial pneumonia, in addition to assessing and classifying studies as to the grade of recommendation and level of evidence. The review was based on PubMed, LILACS, and Scopus databases, from January 1st, 2000 until December 31st, 2012. Studies evaluating oral hygiene care related to nosocomial infections in patients hospitalized in intensive care units were selected according to the inclusion criteria. Full published articles available in English, Spanish, or Portuguese, which approached chemical or mechanical oral hygiene techniques in preventing pneumonia, interventions performed, and their results were included. After analysis, the articles were classified according to level of evidence and grade of recommendation according to the criteria of the Oxford Centre for Evidence-Based Medicine. A total of 297 abstracts were found, 14 of which were full articles that met our criteria. Most articles included a study group with chlorhexidine users and a control group with placebo users for oral hygiene in the prevention of pneumonia. All articles were classified as B in the level of evidence, and 12 articles were classified as 2B and two articles as 2C in grade of recommendation. It was observed that the control of oral biofilm reduces the incidence of nosocomial pneumonia, but the fact that most articles had an intermediate grade of recommendation makes clear the need to conduct randomized controlled trials with minimal bias to establish future guidelines for oral hygiene in intensive care units.

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Evaluation of simple criteria to predict successful weaning from mechanical ventilation in intensive care patients

British Journal of Anaesthesia ◽

10.1093/bja/aeh139 ◽

2004 ◽

Vol 92 (6) ◽

pp. 793-799 ◽

Cited By ~ 36

Author(s):

T.S. Walsh ◽

S. Dodds ◽

F. McArdle

Keyword(s):

Mechanical Ventilation ◽

Intensive Care ◽

Weaning From Mechanical Ventilation ◽

Intensive Care Patients ◽

Successful Weaning

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Hospital-acquired pressure ulcers and risk of hospital mortality in intensive care patients on mechanical ventilation

Journal of Evaluation in Clinical Practice ◽

10.1111/jep.12137 ◽

2014 ◽

Vol 20 (4) ◽

pp. 362-368 ◽

Cited By ~ 25

Author(s):

Francisco Manzano ◽

Ana M. Pérez-Pérez ◽

Susana Martínez-Ruiz ◽

Cristina Garrido-Colmenero ◽

Delphine Roldan ◽

...

Keyword(s):

Mechanical Ventilation ◽

Intensive Care ◽

Hospital Mortality ◽

Pressure Ulcers ◽

Intensive Care Patients ◽

Hospital Acquired

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Effect of abdominal massage on prevention of aspiration in intubated and enterally fed patients: A randomized controlled trial

Journal of Complementary and Integrative Medicine ◽

10.1515/jcim-2017-0124 ◽

2020 ◽

Vol 17 (3) ◽

Author(s):

Mahlagha Dehghan ◽

Amanollah Fatehi Poor ◽

Roghayeh Mehdipour-Rabori ◽

Mehdi Ahmadinejad

Keyword(s):

Intensive Care ◽

Confidence Interval ◽

Endotracheal Tube ◽

Intervention Group ◽

Control Group ◽

Controlled Clinical Trial ◽

Respiratory Secretion ◽

Intensive Care Patients ◽

Randomized Controlled ◽

Abdominal Massage

AbstractBackgroundAspiration is a serious side effect of delayed gastric emptying and increased residual volume in intensive care patients. Aspiration can increase the risk of pneumonia and death. Currently, pharmaceutical methods are the most commonly used techniques for decreasing aspiration, but non-pharmaceutical methods may also be effective in reducing aspiration. One of these methods is an abdominal massage. The present study aimed to examine the effect of abdominal massage on aspiration incidence in intensive care patients with an endotracheal tube.MethodsThis study was a randomized controlled clinical trial. Seventy intensive care patients with an endotracheal tube were chosen by convenience sampling and allocated to an intervention or a control group by the minimization method. The intervention group was provided with a 15-min abdominal massage twice a day for 3 days, while the control group received only routine cares. The patients’ respiratory secretion was suctioned before and after the intervention, and immediately after suctioning, the incidence of the aspiration was assessed using special strips which are sensitive to respiratory secretion pH and glucose. SPSS 18 was used to analyze data. Descriptive statistics were used. T independent, Mann-Whitney U, χ2, and Fisher exact tests were used to compare two groups.ResultsThe incidence rates of the aspiration were 5.7% (confidence interval: 0.0–14.3%) and 20% (confidence interval: 8.6–34.3%) in the abdominal massage and the control groups, respectively. The incidence of aspiration differed between two groups, but it was not statistically significant (p=0.07).ConclusionAlthough the low rate of aspiration in the abdominal massage group did not differ significantly with that of the control group, it can be clinically important. It is suggested that further studies be conducted to confirm the effect of abdominal massage on the prevention of aspiration in intensive care patients with an endotracheal tube.

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