Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, 350 West Thomas Road, Phoenix, AZ 85013, USA.
Neurocrit Care. 2011 Apr;14(2):281-6. doi: 10.1007/s12028-011-9502-2.
Poor oral hygiene has been associated with ventilator-acquired pneumonia. Yet providing oral care for intubated patients is problematic. Furthermore, concerns that oral care could raise intracranial pressure (ICP) may cause nurses to use foam swabs to provide oral hygiene rather than tooth brushing as recommended by the American Association of Critical-Care Nurses. Evidence is needed to support the safety of toothbrushing during oral care. We therefore evaluated ICP and cerebral perfusion pressure (CPP) during oral care with a manual or electric toothbrush in intubated patients in a neuroscience intensive care unit (ICU).
As part of a larger 2-year, prospective, randomized clinical trial, 47 adult neuroscience ICU patients with an ICP monitor received oral care with a manual or electric toothbrush. ICP and CPP were recorded before, during, and after oral care over the first 72 h of admission.
Groups did not differ significantly in age, gender, or severity of injury. Of 807 ICP and CPP measurements obtained before, during, and after oral care, there were no significant differences in ICP (P = 0.72) or CPP (P = 0.68) between toothbrush methods. Analysis of pooled data from both groups revealed a significant difference across the three time points (Wilks' lambda, 12.56; P < 0.001; partial η(2), 0.36). ICP increased significantly (mean difference, 1.7 mm Hg) from before to during oral care (P = 0.001) and decreased significantly (mean difference, 2.1 mm Hg) from during to after oral care (P < 0.001).
In the absence of preexisting intracranial hypertension during oral care, tooth brushing, regardless of method, was safely performed in intubated neuroscience ICU patients.
口腔卫生不良与呼吸机相关性肺炎有关。然而，为插管患者提供口腔护理存在问题。此外，人们担心口腔护理可能会升高颅内压（ICP），这可能导致护士使用泡沫棉签而不是按照美国危重病护理协会的建议进行刷牙来提供口腔卫生。需要证据来支持在口腔护理期间刷牙的安全性。因此，我们评估了在神经重症监护病房（NICU）的插管患者中使用手动或电动牙刷进行口腔护理时的 ICP 和脑灌注压（CPP）。
作为一项为期 2 年的前瞻性随机临床试验的一部分，47 名接受 ICP 监测的成人神经 NICU 患者接受了手动或电动牙刷的口腔护理。在入院后的前 72 小时内，在口腔护理前后记录 ICP 和 CPP。
两组在年龄、性别或损伤严重程度方面无显著差异。在口腔护理前后共获得了 807 次 ICP 和 CPP 测量值，两种牙刷方法之间在 ICP（P = 0.72）或 CPP（P = 0.68）方面没有显著差异。对两组 pooled 数据的分析显示，在三个时间点上有显著差异（Wilks' lambda，12.56；P < 0.001；部分 η(2)，0.36）。与口腔护理前相比，口腔护理期间 ICP 显著升高（平均差异，1.7mmHg）（P = 0.001），与口腔护理期间相比，口腔护理后 ICP 显著降低（平均差异，2.1mmHg）（P < 0.001）。
在口腔护理期间不存在先前存在的颅内高压的情况下，无论使用哪种方法，为插管的神经 NICU 患者刷牙都是安全的。
