Efeitos da adoção de cuidados orais odontológicos sem o emprego de antissépticos em comparação com higiene oral com clorexidina na ocorrência de pneumonia associada a ventilação mecânica em pacientes internados em uma unidade de terapia intensiva: ensaio clínico randomizado

Abstract

INTRODUCTION: Mechanical ventilation (MV) is an important life support measure for critically ill patients; however, its prolonged use can lead to complications, such as ventilator-associated pneumonia (VAP). Aspiration of the oral flora is the main route for the development of VAP, making oral care an essential component in prevention protocols. However, there is still no consensus on the most effective strategy for this practice. OBJECTIVES: The primary objective was to evaluate the impact of an oral care strategy focusing on mechanical plaque disruption, through brushing and using distilled water, compared to oral cleaning with chlorhexidine, on the incidence of VAP. The secondary objective was to assess the impact of this strategy on: MV duration, MV free days at day 28, length of intensive care unit (ICU) and hospital stay, ICU free days at day 28, mortality at day 28, ICU and hospital mortality, and the evolution of oral health indices. METHODS: A single-center, open-label, randomized clinical trial was conducted in a general ICU for adult patients. Patients on MV for more than 48 hours were included in the study. The intervention group (IG) (n = 26) received dental care from a dentist, five times a week, including mechanical plaque removal from teeth and tongue by brushing, without the use of antiseptics. The control group (CG) (n = 25) received routine oral hygiene performed by the ICU nursing team, using chlorhexidine. Demographic and clinical characteristics of the patients were recorded at ICU admission. Throughout hospitalization, patients were monitored daily for the occurrence of VAP, MV necessity, and other clinical variables. The first dental evaluation was performed 48 hours after randomization, followed by evaluations every 7 days until day 28, ICU discharge, or death. The dentist collected data for applying the Simplified Oral Hygiene Index (IHO-S), Lingual Coating Index (TCI), Decayed, Missing, and Filled Teeth Index (DMFT), Beck Oral Assessment Scale modified (BOAS), and Löe Gingival Index (LGI). RESULTS: Oral health was improved in the IG, as evidenced by the reduction in the IHO-S, TCI, and BOAS, compared to the CG. However, there was no significant difference between the groups in the incidence of VAP, which was 42.3% in the IG and 40.0% in the CG [relative risk = 1.05 (95% CI, 0.61–1.80); P = 0.99]. No significant differences were observed between the two groups regarding 28-day mortality, ICU mortality, MV days, and ICU length of stay. CONCLUSION: Oral care provided by the dentist improves the oral health conditions of patients on MV. However, the impact of this care, compared to the application of chlorhexidine, on the incidence of VAP, hospitalization time, and mortality still needs to be clarified.