Oral health status and development of ventilator-associated pneumonia

A descriptive study

Cindy L. Munro, Mary Jo Grap, R. K. Elswick, Jessica McKinney, Curtis N. Sessler, Russell S. Hummel

Research output: Contribution to journalArticle

61 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)453-460
Number of pages8
JournalAmerican Journal of Critical Care
Volume15
Issue number5
StatePublished - Sep 1 2006

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Ventilator-Associated Pneumonia
Oral Health
Health Status
Dental Plaque
Lung
Infection
APACHE
Lactoferrin
Intubation
Oropharynx
Trachea
Pneumonia
Morbidity
Mortality

ASJC Scopus subject areas

  • Medicine(all)
  • Nursing(all)

Cite this

Munro, C. L., Grap, M. J., Elswick, R. K., McKinney, J., Sessler, C. N., & Hummel, R. S. (2006). Oral health status and development of ventilator-associated pneumonia: A descriptive study. American Journal of Critical Care, 15(5), 453-460.

Oral health status and development of ventilator-associated pneumonia : A descriptive study. / Munro, Cindy L.; Grap, Mary Jo; Elswick, R. K.; McKinney, Jessica; Sessler, Curtis N.; Hummel, Russell S.

In: American Journal of Critical Care, Vol. 15, No. 5, 01.09.2006, p. 453-460.

Research output: Contribution to journalArticle

Munro, CL, Grap, MJ, Elswick, RK, McKinney, J, Sessler, CN & Hummel, RS 2006, 'Oral health status and development of ventilator-associated pneumonia: A descriptive study', American Journal of Critical Care, vol. 15, no. 5, pp. 453-460.
Munro CL, Grap MJ, Elswick RK, McKinney J, Sessler CN, Hummel RS. Oral health status and development of ventilator-associated pneumonia: A descriptive study. American Journal of Critical Care. 2006 Sep 1;15(5):453-460.
Munro, Cindy L. ; Grap, Mary Jo ; Elswick, R. K. ; McKinney, Jessica ; Sessler, Curtis N. ; Hummel, Russell S. / Oral health status and development of ventilator-associated pneumonia : A descriptive study. In: American Journal of Critical Care. 2006 ; Vol. 15, No. 5. pp. 453-460.
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AB - 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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