Bellissimo-Rodrigues Wanessa T, Menegueti Mayra G, Gaspar Gilberto G, Nicolini Edson A, Auxiliadora-Martins Maria, Basile-Filho Anibal, Martinez Roberto, Bellissimo-Rodrigues Fernando
Infectious Diseases Division, Internal Medicine Department, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil.
Infect Control Hosp Epidemiol. 2014 Nov;35(11):1342-8. doi: 10.1086/678427. Epub 2014 Oct 2.
To evaluate whether dental treatment may enhance oral antisepsis, thus preventing more effectively lower respiratory tract infections (LRTIs) among critically ill patients.
Observer-blind randomized clinical trial.
General intensive care unit (ICU) for adult patients.
We analyzed data from 254 adult patients who stayed for at least 48 hours in the ICU.
Patients were randomized by means of rolling dice. The experimental group (n = 127) had access to dental care provided by a dental surgeon, 4-5 times a week. Besides routine oral hygiene, care also included teeth brushing, tongue scraping, removal of calculus, atraumatic restorative treatment of caries, and tooth extraction. The control group (n = 127) had access to routine oral hygiene only, which included the use of chlorhexidine as a mouth rinse, which was performed by the ICU nurse staff.
The primary study outcome was the LRTI incidence, which was 8.7% in the experimental group and 18.1% in the control group (adjusted relative risk [RR], 0.44 [95% confidence interval (CI), 0.20-0.96]; P = .04). Ventilator-associated pneumonia rates per 1,000 ventilator-days were 16.5 (95% CI, 9.8-29.5) in the control group and 7.6 (95% CI, 3.3-15.0) in the experimental group (P < .05). Mortality rates were similar between both study groups: 31.5% in the control group versus 29.1% in the experimental group (adjusted RR, 0.93 [95% CI, 0.52-1.65]; P = .796). No severe adverse events related to oral care were observed during the study.
Dental treatment was safe and effective in the prevention of LRTI among critically ill patients who were expected to stay at least 48 hours in the ICU.
Brazilian Clinical Trials Registry, affiliated with the World Health Organization's International Clinical Trial Registry Platform: U1111-1152-2671.
评估牙科治疗是否可增强口腔抗菌作用，从而更有效地预防重症患者的下呼吸道感染（LRTIs）。
观察者盲法随机临床试验。
成人患者综合重症监护病房（ICU）。
我们分析了254例在ICU住院至少48小时的成年患者的数据。
通过掷骰子对患者进行随机分组。实验组（n = 127）每周可接受4 - 5次牙科医生提供的牙科护理。除常规口腔卫生护理外，护理还包括刷牙、刮舌、清除牙结石、龋齿的无创修复治疗以及拔牙。对照组（n = 127）仅接受常规口腔卫生护理，包括由ICU护士使用洗必泰进行口腔冲洗。
主要研究结局是LRTI发病率，实验组为8.7%，对照组为18.1%（校正相对风险[RR]，0.44[95%置信区间(CI)，0.20 - 0.96]；P = 0.04）。每1000个呼吸机日的呼吸机相关性肺炎发生率，对照组为16.5（95%CI，9.8 - 29.5），实验组为7.6（95%CI，3.3 - 15.0）（P < 0.05）。两个研究组的死亡率相似：对照组为31.5%，实验组为29.1%（校正RR，0.93[95%CI，0.52 - 1.65]；P = 0.796）。研究期间未观察到与口腔护理相关的严重不良事件。
对于预计在ICU住院至少48小时的重症患者，牙科治疗在预防LRTI方面安全有效。
巴西临床试验注册中心，隶属于世界卫生组织国际临床试验注册平台：U1111 - 1152 - 2671。
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