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American Journal of Critical Care. 2009;18: 319-328 doi:10.4037/ajcc2009121
Copyright © 2009 by the American Association of Critical-Care Nurses.
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CE Article

Oral Care Interventions and Oropharyngeal Colonization in Children Receiving Mechanical Ventilation

By Mavilde L.G. Pedreira, RN, PhD, Denise M. Kusahara, RN, MNSc, Werther Brunow de Carvalho, MD, PhD, Silvia Cristina Núñez, DDS, PhD and Maria Angélica S. Peterlini, RN, PhD. Mavilde L.G. Pedreira and Maria Angélica S. Peterlini are adjunct professors and Denise M. Kusahara is a pediatric critical care nurse, Nursing School, and Werther Brunow de Carvalho is an adjunct professor, Pediatrics Department, of the Federal University of São Paulo, Brazil. Silvia Cristina Núñez is a professor, Research Center for Dentistry Training and Advancement, São Paulo, Brazil.

Corresponding author: Mavilde Luz Gonçalves Pedreira, Nursing School, Federal University of São Paulo, Rua Napoleão de Barros, 754 office 113, Vila Clementino-São Paulo-Capital, Brazil CEP 04024002 (e-mail: mpedreira{at}unifesp.br).

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.

Notice to CE enrollees:A closed-book, multiple-choice examination following this article tests your understanding of the following objectives:
  1. Describe the incidence of ventilator-associated pneumonia in the pediatric intensive care unit (PICU) patient population.
  2. Identify microorganisms that commonly colonize the oropharynx of PICU patients.
  3. Recognize the impact of an oral care routine using chlorhexidine on a PICU study group.
To read this article and take the CE test online, visit www.ajcconline.org and click "CE Articles in This Issue." No CE test fee for AACN members.


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C. Lizy, N. Brusselaers, S. Labeau, D. Vandijck, D. De Wandel, D. Vogelaers, and S. Blot
Oral Care, Ventilator-Associated Pneumonia, and Counting Cultures
Am. J. Crit. Care., November 1, 2009; 18(6): 507 - 509.
[Full Text] [PDF]


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