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Electric Versus Manual Tooth Brushing among Neuroscience ICU Patients: Is it Safe?

Prendergast, Virginia LU ; Hagell, Peter LU and Rahm Hallberg, Ingalill LU (2011) In Neurocritical Care 14(2). p.281-286
Abstract
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... (More)
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 eta(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. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Oral care, Neurocritical care, Neuroscience nursing, Neurosurgical, intensive care, Neurosurgical perioperative care
in
Neurocritical Care
volume
14
issue
2
pages
281 - 286
publisher
Humana Press
external identifiers
  • wos:000288663800021
  • scopus:79955848697
ISSN
1541-6933
DOI
10.1007/s12028-011-9502-2
language
English
LU publication?
yes
id
3eb1cc87-d042-48f3-b58a-b450ce639719 (old id 1925784)
date added to LUP
2011-05-02 09:01:53
date last changed
2017-03-19 03:08:40
@article{3eb1cc87-d042-48f3-b58a-b450ce639719,
  abstract     = {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 &lt; 0.001; partial eta(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 &lt; 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.},
  author       = {Prendergast, Virginia and Hagell, Peter and Rahm Hallberg, Ingalill},
  issn         = {1541-6933},
  keyword      = {Oral care,Neurocritical care,Neuroscience nursing,Neurosurgical,intensive care,Neurosurgical perioperative care},
  language     = {eng},
  number       = {2},
  pages        = {281--286},
  publisher    = {Humana Press},
  series       = {Neurocritical Care},
  title        = {Electric Versus Manual Tooth Brushing among Neuroscience ICU Patients: Is it Safe?},
  url          = {http://dx.doi.org/10.1007/s12028-011-9502-2},
  volume       = {14},
  year         = {2011},
}