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American Journal of Critical Care. 2006;15: 453-460
Copyright © 2006 by the American Association of Critical-Care Nurses.
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Oral Health Status and Development of Ventilator-Associated Pneumonia: A Descriptive Study

By Cindy L. Munro, RN, PhD, ANP, Mary Jo Grap, RN, PhD, ACNP, R.K. Elswick, Jr, PhD, Jessica McKinney, BS, Curtis N. Sessler, MD and Russell S. Hummel, III, BS, MS. From Adult Health Department, School of Nursing (CLM, MJG, RKE), Department of Biostatistics (RKE, JM), Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine (CNS), and Department of Surgery (RSH), School of Medicine, Virginia Commonwealth University, Richmond, Va.

Corresponding author: Cindy L. Munro, RN, PhD, ANP, Professor, School of Nursing, Virginia Commonwealth University, Box 980567, Richmond, VA 23298-0567 (e-mail: cmunro{at}vcu.edu).

• Background Ventilator-associated pneumonia is a significant cause of morbidity and mortality and may be influenced by oral health.

• Objective To describe the relationship between ventilator-associated pneumonia and oral health status, changes in oral health status during the first 7 days after intubation, and microbial colonization of the oropharynx and trachea.

• Methods A total of 66 patients were enrolled within 24 hours of intubation and were followed up for up to 7 days. Data on oral health measures and the Clinical Pulmonary Infection Score (CPIS) were collected at baseline, day 4 (n = 37), and day 7 (n = 21). A regression model was used to predict risk of pneumonia at day 4.

• Results Dental plaque and oral organisms increased over time. Correlations were significant for baseline and day 4 dental plaque (P < .001), baseline salivary lactoferrin and day 4 plaque (P = .01), and lower salivary volume and higher day 4 CPIS (P = .02). Potential pathogens were identified in oral cultures for 6 patients before or at the same time as the appearance of the organisms in tracheal aspirates. Correlations were significant with day 4 CPIS for score on the Acute Physiology and Chronic Health Evaluation (APACHE) II (P = .007), day 4 salivary volume (P = .02), interaction of APACHE II score and day 1 CPIS (P<.001), and interaction of day 1 CPIS and plaque (P=.01).

• Conclusions Higher dental plaque scores confer greater risk for ventilator-associated pneumonia, particularly for patients with greater severity of illness. Salivary volume and lactoferrin may affect the risk.




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