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IMPACT OF IMPROVEMENT IN PREOPERATIVE ORAL HEALTH ON NOSOCOMIAL PNEUMONIA IN A GROUP OF CARDIAC SURGERY PATIENTS: A SINGLE ARM PROSPECTIVE INTERVENTION STUDY
Chlorhexidine
Cardiac Surgical Procedures
Oral Hygiene
Tongue
Dentures
Clorexidina
Procedimentos Cirúrgicos Cardíacos
Higiene Bucal
Língua
Dentaduras
Affilliation
Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil / Instituto Nacional de Cardiologia. Rio de Janeiro, RJ, Brasil
Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil / Instituto Nacional de Cardiologia. Rio de Janeiro, RJ, Brasil
Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil / Instituto Nacional de Cardiologia. Rio de Janeiro, RJ, Brasil / Universidade do Grande Rio. Rio de Janeiro, RJ, Brasil
Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil / Instituto Nacional de Cardiologia. Rio de Janeiro, RJ, Brasil
Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil / Instituto Nacional de Cardiologia. Rio de Janeiro, RJ, Brasil / Universidade do Grande Rio. Rio de Janeiro, RJ, Brasil
Abstract
Purpose: To evaluate
the effects of an oral health protocol
on the incidence of postoperative
pneumonia in patients submitted to
coronary artery bypass grafting and to
valve surgery. Methods: All
patients admitted to a public cardiac
surgery hospital were examined by a
dentist and had a thorough dentistry
anamnesis and an intraoral exam
focusing on teeth, gums, and tongue.
Patients were taught how to brush
their teeth and tongue and how to
clean their jugal and palatal membranes.
Chlorhexidine gluconate
(CXG) 0.12 % oral rinse twice a day
was used until surgery. Data on age,
sex, comorbidities, oral evaluation,
type of surgery, and development of
pneumonia were obtained. Statistical
analysis was done on these variables
to evaluate the impact of the study
protocol. Results: A total of 226
patients were enrolled, 136 male
(60.2 %). The median age was
59 years. There were 123 (54.4 %)
patients with coronary artery disease
and 103 (45.6 %) with valve disease.
There were 18/226 (8 %) postoperative
pneumonias (PP), nine in each
group. Ten occurred in dentate
patients and eight in edentulous ones.
Oral health optimization was
achieved in 208/226 (92 %) of
patients in the preoperative period.
The presence of tongue plaque (OR
17, P\0.001) and of poor hygiene
of the total superior dentures (OR 25,
P\0.001) in the preoperative period
significantly increased the chance of
PP. The use of CXG 0.12 % in the
preoperative period (OR 0.06,
P\0.001) and on the day of surgery
(OR 0.002, P\0.001) was protective
against PP. Mortality in patients
without pneumonia was 9/208
(4.32 %) vs. 6/19 (33.3 %) in those
with pneumonia. The presence of
pneumonia increased the chances of
death by 11 times (P\0.001). The
mean pneumonia rate in ICU in the
6 months before the study protocol
was 32 per 1,000 ventilator-days, 24
during the 6-month intervention period,
and 10 during the next 6 months
following the study. Conclusions:
PP rates were reduced using
a simple and efficient protocol of
dental care that improved oral
hygiene in the preoperative period of
cardiac surgery patients.
Keywords
Pneumonia, Ventilator-AssociatedChlorhexidine
Cardiac Surgical Procedures
Oral Hygiene
Tongue
Dentures
DeCS
Pneumonia Associada à Ventilação MecânicaClorexidina
Procedimentos Cirúrgicos Cardíacos
Higiene Bucal
Língua
Dentaduras
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