Oral care in the ICU. Update and current controversies

ABSTRACT: Introduction: oral care interventions (OC) are aimed to ensure comfort and dignity to the patients in intensive care unit (ICU), prevent infections in the oral cavity, and, more recently, have become a cornerstone in the prevention of ventilator-associated pneumonia (VAP). The state of health of the oral cavity is potentially described as a continuum ranging from the state of complete well-being, (the state of full health that results in high levels of comfort and consequent self-esteem), to the disease, represented by xerostomy, dental plaque biofilm, mouth ulcers, gingivitis, stomatitis, and periodontitis. Aim: this paper aims to provide the latest updates about OC, along with current controversies and some critical insights that can be useful when during the drafting of an evidence based oral hygiene protocol in ICU. Results: There are some key elements to consider in oral health care for adult patients in ICU. The first one is related to the lack of interventions with evidence of efficacy for major outcomes, except for the use of chlorhexidine mouthwash, while toothbrushing , even if doesn’t show efficacy in terms of prevention of VAP, remains the only tool capable to counteract the bacterial plaque. The second one is the fact that the drafting of a protocol of oral hygiene must necessarily include an assessment tool of the oral health status, and all the nursing interventions comprised in the VAP Bundle, with particular attention to the oropharyngeal deep suction, the maintenance of the inflation pressure of the tracheal tube cuff between 25 and 30 cmH2O, and where available, the use of tracheal tubes with subglottic suction lumen.