How to Prevent Ventilator-Associated Pneumonia
Ventilators have been in the news a lot lately, thanks to COVID-19. But while these machines are credited with saving lives, they have a downside.
For patients in respiratory distress, ventilators can spell the difference between life and death. Particularly during the height of the pandemic, ventilators were worth their weight in gold.
Life-sustaining pieces of equipment, ventilators mechanically breathe for a patient via an endotracheal tube that is typically inserted through the mouth or nose and into the trachea.
Once in place, the ventilator pushes a mix of air and oxygen into the lungs to oxygenate the body. It also keeps the lungs’ air sacs from collapsing, helps rid the body of carbon dioxide, and decreases the amount of energy patients must spend on breathing so they can better fight infection.1
Patients put on ventilators, usually in an intensive care unit (ICU), are closely monitored and often given medication to enhance comfort. Some patients may only need to be on them for a few hours. But when those hours stretch into days or longer, risks for undesirable effects may increase.1
THE DOWNSIDE
Complications related to time spent on a ventilator include lung damage, pneumothorax (collapsed lung), medication side effects, and dependence on ventilator support to sustain life.1 In addition, particularly when patients are on ventilators long term, the risk for developing infections goes up. Chief among these is pneumonia.1
Ventilator-associated pneumonia (VAP), which develops at least 48 hours after a patient is placed on a ventilator, is the most common type of infection in mechanically ventilated ICU patients. It has a mortality rate between 33% and 50%.2
VAP develops courtesy of the endotracheal tube, which allows oropharyngeal pathogens easy access into the airways, where they can spread via microaspiration. This can cause nosocomial pneumonia. It doesn’t help that the oral health, especially of long-term ventilated patients, tends to be poor.2
THE KEY MAY LIE IN ORAL HEALTH
In a recent study, researchers at King George’s Medical University in Lucknow, India, investigated how oral care protocols might be used to combat VAP in intubated patients. They observed that within the first 48 hours of intubation, oral flora changes and dental plaque growth accelerates, colonized by Gram-negative bacteria. In fact, it forms faster in ICU patients than in other patients. This bacterium accumulates in the oropharynx and is responsible for VAP.2
They compared the effects of oral care products on development of VAP in 220 ICU patients ages 18 through 65 divided into two groups of 110 each. The study group (S) employed oral care using chlorhexidine mouthrinse; tooth brushing; and moisturizing gel over gingiva, buccal mucosa, and lips. The control group (C) was treated only with chlorhexidine mouthrinse.
Subsequent oral assessments performed, along with chest Xrays and other measures, revealed improvements across the board for group S compared with group C. The study showed that, in addition to other supportive measures, oral care with chlorhexidine mouthrinse reduced VAP as well as mortality and hospital stays. But researchers also found that toothbrushing further decreases the incidence of VAP in mechanically ventilated patients. In fact, toothbrushing reportedly decreased not only the number of patients with VAP but the length of ICU stays, ventilator time, and mortality rates.
