Analysis of oral risk factors for ventilator-associated pneumonia in critically ill patients

Takahama Jr, Ademar; de Sousa, Vitoria Iaros; Tanaka, Elisa Emi; Ono, Evelise; Ito, Fernanda Akemi Nakanishi; Costa, Priscila Paganini; Pedriali, Maria Beatriz Bergonse Pereira; de Lima, Heliton Gustavo; Fornazieri, Marco Aurélio; Correia, Leticia Sassaki; Cardoso, Lucienne Tibery Queiroz; de Maio Carrilho, Claudia Maria Dantas

OBJECTIVE: This a cross-sectional study to evaluate the association between oral health findings and ventilator-associated pneumonia (VAP) among critically ill patients in intensive care units (ICU). MATERIAL AND METHODS: Data were collected from medical records, and a detailed oral physical examination was performed on 663 critically ill patients on mechanical ventilation. Data were statistically analysed using univariate and logistic regression models relating the development of VAP with the oral findings. RESULTS: At oral physical examination, the most frequent findings were tooth loss (568–85.67%), coated tongue (422–63.65%) and oral bleeding (192–28.96%). Patients with a coated tongue or oral bleeding on the first day of ICU hospitalization developed more VAP than did patients without these conditions (20.14 vs 13.69%, p = 0.02; 23.44 vs 15.50%, p = 0.01, respectively). In the logistic regression, a coated tongue and oral bleeding were considered independent risk factors for VAP development (OR = 1.61 (1.03–2.51) and OR = 1.69 (1.08–2.66), respectively). CONCLUSIONS: The presence of a coated tongue and oral bleeding in ICU admission could be considered markers for the development of VAP. CLINICAL RELEVANCE: The results of this paper reinforce the importance of proper maintenance of oral hygiene before intubation, which may lead to a decrease in the incidence of VAP in the ICU.