La utilización de antisépticos en la higiene bucal de pacientes intubados conforme a la evidencia

Abstract

Background Permanence of an endotracheal tube makes an adequate mouth more difficult, and that is an important care for oral health. Improvement in oral care can reduce risks of complications, such as inctubation associated pneumonia, and there are a lot of antiseptic substances used frequently with inctubated patients to prevent them. Aims 1- Identifying evidences and recommendations about oral higiene in inctubated patients at ICU. 2- Studying methods of oral hygiene in mature inctubated patients linked to the antiseptic and dilution, frequency of care and related problems (inctubation associated pneumonia and mucosithis). Evaluation methods and selection of studies in this report Kind of studies: originals of any design and clinical test related to oral care in inctubated patients. Subjects of study: mature patients in ICU units linked to mechanical ventilation. Cares: any intervention in oral care: brushing, rinsing, dilutions, frequency of care...including any kind of antiseptic or oral care products. Measures of results: mechanical ventilation associated pneumonia, bacteriological controls, odour decreasing, days of staying, mucosity. The aim of this report is identifying interventions related to frequency of care, antiseptic or product aplied, humor, frequency of oral humor aspiration. Research method To obtain a clear answer to this problem, a research in the following data base was carried: PubMed-Medline, Cochrane library plus, Cuiden, Cuiden Plus, Lilacs, Scielo-BVS, EbscoHost, Academic Search Premier and Doyma. Method reseach were developed to each data base. Research results Sistematic checkings about oral care in inctubated patients were not found. In 31 reports, clinical essays were identified and analyzed separated from descriptive studies. In testing studies, where several groups and methods were compared, we selected those referred to results related to number of mechanical ventilation associated pneumonias. Checking methods Selection methods: all the identified reports during the research strategy were checked by two people separately. Complete studies of those that seemed to achieve inclusion criterion were obtained. Studied were evaluated in pairs separately. Opposition in points of view were solved by agreement. Methodological quality and evidence clasification: in order to evaulate results, EBWG cuantitative hyerarchy evidence clasification and quality level of evidences were aplied. Data summary: tabulation. Data were recorded in specially designed forms including general data (author, title, magazine, date of releasing), subjects features, designg and methodology, interventions, results and conclussions. Authors´ conclussions. Antiseptic rinsing would not be recommended in daily care. Chlorexidrine gluconate in 0.12 would be recommended for pre-surgery (heart surgery) patients. Oral care frecuency is related to mouth wellfare. Best results were obtained in mixed method, in a specific oral care program carried by trained staff.