Associação entre saúde bucal e pneumonia associada à ventilação mecânica: estudo de coorte

Abstract

Objective: To describe the prevalence of dental and tongue plaque, and periodontal diseases in Mechanically Ventilated Patients (MVP), and the correlation of these conditions with the occurrence of Ventilator-Associated Pneumonia (VAP). Methods: This prospective cohort study included patients who received Mechanical Ventilation (MV) through an endotracheal tube. Patients were followed from day 0 (the first day under MV) to day 28, ICU discharge or death, whichever happened first. The following exposure variables were collected on day 1 and day 7 by trained dentists: number of teeth, Simplified Oral Hygiene Index (OHI-S), the presence of tongue plaque, and Löe Gingival Index (LGI). Results: The final cohort was composed of 55 patients, 11 who developed VAP and 44 who did not. On the first day of MV, 23.6% of the patients presented periodontal disease and 34.6% presented tongue plaque. On day 7, 77.8% of the patients in the VAP group had tongue plaque versus 36.7% in the non-VAP group (p=0.06), and 44.4% in the VAP group had periodontal disease versus 13.3% in the non-VAP group (p=0.07). The multivariable analysis showed that the tongue plaque on day 7, periodontal disease on day 1 and day 7 were independently associated with the occurrence of VAP, after adjustments for age and SAPS-3. Conclusion: patients admitted to the ICU-HU-UFJF and undergoing MV have a high prevalence of dental and tongue plaque and periodontal disease and the presence of tongue plaque on the seventh day of MV and periodontal disease on the first and seventh day of MV are associated increased risk of VAP in critically ill patients.