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American Journal of Critical Care. 2009;18: 368-376 doi:10.4037/ajcc2009621
Copyright © 2009 by the American Association of Critical-Care Nurses.
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Oral Health, Ventilator-Associated Pneumonia, and Intracranial Pressure in Intubated Patients in a Neuroscience Intensive Care Unit

By Virginia Prendergast, RN, MSN, NP, Ingalill Rahm Hallberg, RNT, PhD, Heidi Jahnke, RN, MSN, Cindy Kleiman, BS, RDH and Peter Hagell, RN, PhD. Virginia Prendergast is a nurse practitioner at Barrow Neurological Institute, St Joseph’s Hospital and Medical Center, Phoenix, Arizona; and a doctoral candidate in the Department of Health Sciences, Lund University, Lund, Sweden. Ingalill Rahm Hallberg is a professor and Peter Hagell is an associate professor in the Department of Health Sciences, Lund University. Heidi Jahnke is a research nurse clinician at St Joseph’s Hospital and Medical Center in Phoenix, and Cindy Kleiman is an oral care consultant and adjunct faculty member at Phoenix College, Phoenix, Arizona.

Corresponding author: Virginia Prendergast, RN, MSN, NP, Barrow Neurological Institute, St Joseph’s Hospital and Medical Center, 350 W Thomas Rd, Phoenix, AZ 85251 (e-mail: Virginia.Prendergast{at}chw.edu).

Background Although oral health affects systemic health, studies of oral health during intubation among critically ill neuroscience patients are lacking. Furthermore, the effect of oral care on intracranial pressure among critically ill patients in a neuroscience intensive care unit is unknown.

Objectives To describe changes in oral health and development of ventilator-associated pneumonia during intubation among patients in a neuroscience intensive care unit and to assess the influence of oral care on intracranial pressure.

Methods Data on 45 consecutive intubated patients admitted to a neuroscience intensive care unit during 1 year were collected by using oral cultures and the Oral Assessment Guide throughout intubation and 48 hours after extubation. Occurrence of ventilator-associated pneumonia and intracranial pressures associated with oral care were recorded.

Results Oral health, assessed by the Oral Assessment Guide, deteriorated significantly during intubation and improved to almost baseline levels 48 hours after extubation. During intubation, occurrence of oral gram-negative bacteria and yeast increased. The incidence of ventilator-associated pneumonia was 24% among patients enrolled for 4 to 10 days. During or after 879 instances of oral care, overall intracranial pressure did not increase. Among 30 instances in which intracranial pressure was greater than 20 mm Hg before oral care, pressure decreased during and 30 minutes after the procedure (P < .001).

Conclusions Intubation may contribute to worsening of oral health among patients in neuroscience intensive care units. Execution of oral care does not seem to affect intracranial pressure adversely. Oral care should be explored further to promote good oral and systemic health in patients in neuroscience intensive care units and to determine its effect on ventilator-associated pneumonia.


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Copyright © 2009 by the American Association of Critical-Care Nurses.