Condições de saúde bucal de pacientes críticos e sua associação com a ocorrência de pneumonia associada à ventilação mecânica

Abstract

INTRODUCTION: Ventilator-associated pneumonia (VAP) is one of the most common hospital-acquired infections and the most prevalent among critically ill patients. The main factor in the pathogenesis of VAP is the aspiration of pathogenic bacteria that colonize the oral cavity and oropharynx. This colonization is exacerbated by poor oral health conditions due to the accumulation of biofilms, which act as reservoirs for respiratory pathogens that cause VAP. OBJECTIVES: To characterize the oral health conditions of critically ill patients and to evaluate the associations between oral health and the occurrence of ventilator-associated pneumonia (VAP). METHODS: This is a post hoc analysis of a randomized clinical trial that included adults’ patients that received mechanical ventilation (MV) for at least 48 hours. The patients' oral health indices evaluation occurred within 48 hours after intubation and included: Decayed, Missing, and Filled Teeth Index (DMFT); Simplified Debris Index (DI-S); Simplified Calculus Index (CI-S); Tongue Coating Index (TCI); Löe Gingival Index (LGI); and the modified Beck Oral Assessment Scale (BOAS). The primary outcome was the occurrence of VAP. Secondary outcomes included: weaning success rates, frequency of tracheostomy, days free from MV within 28 days, days free from intensive care unit (ICU) within 28 days, and 28-day, ICU and hospital mortality. RESULTS: This study included 71 patients who exhibited poor oral health conditions, characterized by elevated indices of DMFT, DI-S, CI-S, TCI, LGI, and BOAS. None of the oral health indices assessed were associated with the occurrence of VAP. However, higher values of DMFT were associated with higher risk of ICU mortality [odds ratio = 1.08 (95% CI = 1.01 – 1.15) in the univariable analysis; odds ratio = 1.08 (95% CI = 0.99 – 1.17) in the multivariable analysis]. CONCLUSION: A high prevalence of poor oral health conditions was identified among critically ill patients, which was not associated with the occurrence of VAP.