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Oral Care of Intubated Patients

Blot, Stijn PhD*†; Vandijck, Dominique MA; Labeau, Sonia MNSc†‡

Clinical Pulmonary Medicine: May 2008 - Volume 15 - Issue 3 - p 153-160
doi: 10.1097/CPM.0b013e3181729250
Clinical Practice Management

Receiving care in an intensive care unit (ICU) can greatly influence patients’ survival and quality of life. The benefit achieved in terms of improved survival rates is particularly attributed to the favorable changes in supportive care made over the past decades. The improved acute phase survival, however, was associated with a growing number of long-term ICU residents at high risk for infection, especially when orally intubated. Today, one of the most dreaded complications associated with endotracheal intubation is ventilator-associated pneumonia. Bad oral health and microaspiration of subglottic secretions and debris are pivotal in the pathogenesis of this harmful complication. Good oral hygiene is a key issue in preventing dental plaque formation and microbial growth in the mouth. However, evidence-based recommendations for oral care are not available. Therefore, substantial efforts aiming to provide this information are urgently needed, as well as training and motivation of all health care workers involved in the care of intubated patients. In the meantime, providing adequate chemical (ie, use of chlorhexidine or povidone-iodine solutions) as well as mechanical (ie, manual or electric toothbrush, and subglottic aspiration) oral care is considered suitable because both approaches may be the main contributing factors to decrease the risk of respiratory infections.

Preserving oral health is a major challenge in patients intubated for a prolonged period of time. Failure to do so increases the risk for dental plaque formation and accumulation of microbial growth in the oral cavity, which in turn increases the risk for ventilator-associated pneumonia. This article summarizes current insights on the impact of bad oral health and oral care practices.

From the *Infectious Disease Department, Ghent University Hospital; †Faculty of Healthcare, University College Ghent; and ‡Faculty of Medicine and Health Science, Ghent University, Ghent, Belgium.

Address correspondence to: Stijn Blot, PhD, Infectious Disease Department, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium. E-mail: stijn.blot@UGent.be.

© 2008 Lippincott Williams & Wilkins, Inc.