Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan.
General Intensive Care Unit, Cho Ray Hospital, Ho Chi Minh City, Viet Nam; Department of Critical Care, Emergency Medicine and Clinical Toxicology, University of Medicine and Pharmacy Ho Chi Minh City, Viet Nam.
J Infect Chemother. 2022 Dec;28(12):1632-1638. doi: 10.1016/j.jiac.2022.08.017. Epub 2022 Aug 29.
Ventilator-associated pneumonia (VAP) has emerged as a critical issue in the intensive care unit (ICU) because of its high burden on patients and medical staff. Here, we examined the potential for reducing VAP incidence through physical oral care interventions without any medication.
This prospective interventional study compared VAP incidence during an 8-month baseline period (usual oral care) and a 9-month intervention period (physical oral care with sponge brush) among patients who received mechanical ventilation for >48 h in a tertiary care hospital in Vietnam from 2017 to 2019. Physical oral care was provided by general ICU nurses who had been trained by dentists and infection control nurses. VAP was diagnosed using the Clinical Pulmonary Infection Score.
In total, 423 patients were enrolled in the baseline group and 454 patients were enrolled in the intervention group; 303 and 300 patients, respectively, were included in the analysis. Two hundred thirty-eight VAP episodes were identified: 135 (44.6%) during the baseline period and 103 (34.3%) during the intervention period. Univariate analysis revealed significant reduction of VAP occurrence in the intervention period (odds ratio = 0.65; 95% confidence interval = 0.47-0.90; P = 0.010). The incidences of VAP per 1000 ventilator-days were 63.4 (135/2128) during the baseline period and 48.4 (103/2128) during the intervention period (P = 0.038).
Physical oral care without any medication (e.g., chlorhexidine) reduced VAP incidence in the ICU. This method could be used to reduce VAP incidence, particularly in countries with limited medical resources.
呼吸机相关性肺炎（VAP）已成为重症监护病房（ICU）的一个重要问题，因为它给患者和医务人员带来了沉重的负担。在这里，我们研究了在不使用任何药物的情况下，通过物理口腔护理干预措施降低 VAP 发病率的可能性。
这是一项前瞻性干预研究，比较了 2017 年至 2019 年期间在越南一家三级医院接受机械通气>48 小时的患者在 8 个月的基线期（常规口腔护理）和 9 个月的干预期（使用海绵刷的物理口腔护理）期间的 VAP 发病率。物理口腔护理由接受过牙医和感染控制护士培训的普通 ICU 护士提供。VAP 采用临床肺部感染评分进行诊断。
共有 423 名患者纳入基线组，454 名患者纳入干预组；分别有 303 名和 300 名患者纳入分析。共发现 238 例 VAP 发作：基线期 135 例（44.6%），干预期 103 例（34.3%）。单因素分析显示，干预期 VAP 发生率显著降低（优势比=0.65；95%置信区间=0.47-0.90；P=0.010）。基线期每 1000 通气日的 VAP 发生率为 63.4（135/2128），干预期为 48.4（103/2128）（P=0.038）。
不使用任何药物（如洗必泰）的物理口腔护理可降低 ICU 的 VAP 发病率。这种方法可用于降低 VAP 发病率，尤其是在医疗资源有限的国家。
