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PNEUMONIA NOSOCOMIAL E DIRETA RELAÇÃO COM A SAÚDE BUCAL (DOENÇA PERIODONTAL) DE PACIENTES INTERNADOS NA UNIDADE DE TERAPIA INTENSIVA: DIRETRIZES E ESTRATÉGIAS CLÍNICAS
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Background: Oral care is often given lower
priority than other nursing interventions in
intensive care units (ICUs) and little work has been
done to measure reliably current oral care practices
nationwide.
Objectives: The objectives of the study were to
explore the type and frequency of oral care
delivered to ventilated patients and the availability
of oral care protocols in the ICU.
Methods: A randomly selected survey was
conducted among 30 intensive ICUs within Egypt
using self-administered questionnaire. The oral
care survey items were designed to elucidate
information on the type and frequency of each
specific task for oral care.
Results: Twenty-eight questionnaires were
received and evaluated (93%). About 64% of all
respondents reported having protocols available for
preventing VAP. Systemic antibiotic regimens
performed by 16 units (57%). Only 6 units (21%)
reported cleaning the patients' teeth mechanically
with a toothbrush. Four units (14%) use
chlorhexidine as a disinfectant. About 78% use the
gel form. Forty three percent of the responding
hospitals performed routine oral cleaning
procedures three times a day. 64% units start oral
care measures immediately after intubation.
Conclusions: Oral care practices were neither
standardized nor consistently implemented in the
evaluated Egyptian intensive care units of the
responding hospitals. Additional and improved
measures have to be determined to confirm or
optimize prophylactic oral strategies and to create
standards and guidelines for this at-risk patient
collective. The use of toothbrushes should be given
more attention.
Objetivo: avaliar a incidência de saburra lingual em pacientes atendidos em unidade de terapia intensiva (UTI) de um hospital do Distrito Federal, Brasil. Material e Métodos: estudo descritivo e prospectivo com coorte de conveniência aprovado pelo Comitê de Ética em Pesquisa. Um único examinador conduziu exames clínicos com foco na avaliação da incidência de saburra lingual em pacientes internados em UTI por cinco semanas, às vezes programadas pelo conselho de administração da UTI. Os dados foram registrados em uma folha de dados padronizada. Resultados: foram avaliados 152 pacientes do sexo masculino e feminino (57% mulheres e 42% homens), com idade média de 64 anos. Os pacientes foram internados na UTI, principalmente sob condições normais (p <0,001); o período mais longo na UTI foi de 48 horas (p <0,001). A maioria dos pacientes (56) apresentou revestimento em suas línguas (p <0,001). Associações entre o tempo de internação hospitalar e a incidência de saburra lingual não foram estatisticamente significantes. Conclusão: a incidência de saburra lingual permanece alta nos pacientes tratados na UTI investigada. Assim, faz-se necessário o desenvolvimento de estratégias educativas e clínicas, bem como a implementação de protocolos de capacitação específica e profissional.
Objective
To evaluate the effectiveness of dental treatment in improving oral health in critical patients.
Methods
This randomised clinical trial was conducted in a general intensive care unit (ICU) at a tertiary care public facility from 1 January 2011 to 8 August 2013. Data from 254 adult patients staying in the ICU for 48 hours or more were analysed. The experimental group (n = 127) had access to dental treatment provided by a dentist four to five times a week, in addition to routine oral hygiene, whereas the control group (n = 127) had access only to routine oral hygiene, including topical application of chlorhexidine, provided by the ICU nursing staff. The baseline oral health status of the enrolled patients was poor and included edentulism, caries, gingivitis, periodontitis and residual roots. Dental treatment consisted of toothbrushing, tongue scraping, removal of calculus, scaling and root planing, caries restoration and tooth extraction.
Results
The Oral Hygiene Index Simplified (OHI‐S) and Gingival Index (GI) scores decreased in the experimental group but did not change significantly in the control group during the ICU stay. Dental treatment prevented most of the episodes of respiratory tract infections, as previously reported. No severe adverse events from the dental treatment were observed.
Conclusion
From an interprofessional perspective, our results support the idea of including dentists in the ICU team to improve oral health in critical patients and effectively prevent respiratory tract infections, in addition to the improvement achievable by applying chlorhexidine alone.
RESUMO As Ligas Acadêmicas são potentes estratégias desencadeadas na formação em saúde, protagonizadas por discentes e supervisionadas por docentes, que integram atividades de ensino, pesquisa e extensão. O objetivo deste trabalho é conhecer a produção científica brasileira acerca das Ligas Acadêmicas a fim de identificar lacunas do conhecimento. Trata-se de um estudo do tipo estado da questão, realizado por meio de busca nas bases de dados Biblioteca Virtual de Saúde (BVS) e no Banco de Teses e Dissertações da Capes. Utilizou-se como palavra-chave “ligas acadêmicas”, seguida pela questão norteadora: “Qual a produção científica acerca das Ligas Acadêmicas?”. Após análise detalhada, foram selecionadas para a amostra final do estudo 24 produções. Verificou-se que a área do conhecimento que mais pesquisa sobre as Ligas Acadêmicas é a medicina, sendo a Revista Brasileira de Educação Médica o periódico com mais publicações sobre esse tema. Identificou-se ainda que preponderaram os seguintes tipos de estudo: relato de experiência e editorial. Os relatos de experiência estavam relacionados principalmente às experiências em Ligas por especialidades e por cursos de graduação. Destaca-se ainda a normatização das Ligas Acadêmicas e as Ligas Acadêmicas e a formação em saúde como objeto de estudo. As Ligas Acadêmicas vêm crescendo em todo o território nacional, destacando-se os cursos de Medicina como precursores destas iniciativas. As principais contribuições para a formação em saúde são a promoção de uma formação embasada na realidade em que os futuros profissionais estarão inseridos, a capacidade de estímulo ao trabalho em equipe, a reflexão crítica e a autonomia dos estudantes. No entanto, são reconhecidos alguns desafios, como a especialização precoce e a falta de supervisão docente efetiva. Com base no tripé da universidade formado pelo ensino, pesquisa e extensão, as Ligas Acadêmicas têm a possibilidade de promover a formação diferenciada em saúde, antecipar a inserção de seus participantes nos campos de atuação e preencher as lacunas do conhecimento encontradas na graduação por meio do protagonismo e da autonomia discentes, além de proporcionar a integração ensino-serviço-comunidade.
Exercise is considered a valuable nonpharmacological intervention modality in cardiac rehabilitation (CR) programs in patients with ischemic heart disease. The effect of aerobic interval exercise combined with alternating sets of resistance training (super-circuit training, SCT) on cardiac patients' with reduced left ventricular function, post-myocardial infarction (MI) has not been thoroughly investigated.to improve cardiac function with a novel method of combined aerobic-resistance circuit training in a randomized control trial by way of comparing the effectiveness of continuous aerobic training (CAT) to SCT on mechanical cardiac function. Secondary to compare their effect on aerobic fitness, manual strength, and quality of life in men post MI. Finally, to evaluate the safety and feasibility of SCT.29 men post-MI participants were randomly assigned to either 12-weeks of CAT (n = 15) or SCT (n = 14). Both groups, CAT and SCT exercised at 60%-70% and 75-85% of their heart rate reserve, respectively. The SCT group also engaged in intermittently combined resistance training. Primary outcome measure was echocardiography. Secondary outcome measures were aerobic fitness, strength, and quality of life (QoL). The effectiveness of the two training programs was examined via paired t-tests and Cohen's d effect size (ES).Post-training, only the SCT group presented significant changes in echocardiography (a reduction in E/e' and an increase in ejection fraction, P
Objective
To evaluate whether dental treatment may enhance oral antisepsis, thus preventing more effectively lower respiratory tract infections (LRTIs) among critically ill patients
Design
Observer-blind randomized clinical trial.
Setting
General intensive care unit (ICU) for adult patients.
Patients
We analyzed data from 254 adult patients who stayed for at least 48 hours in the ICU.
Intervention
Patients were randomized by means of rolling dice. The experimental group ( n = 127) had access to dental care provided by a dental surgeon, 4–5 times a week. Besides routine oral hygiene, care also included teeth brushing, tongue scraping, removal of calculus, atraumatic restorative treatment of caries, and tooth extraction. The control group ( n = 127) had access to routine oral hygiene only, which included the use of chlorhexidine as a mouth rinse, which was performed by the ICU nurse staff.
Results
The primary study outcome was the LRTI incidence, which was 8.7% in the experimental group and 18.1% in the control group (adjusted relative risk [RR], 0.44 [95% confidence interval (CI), 0.20–0.96]; P = .04). Ventilator-associated pneumonia rates per 1,000 ventilator-days were 16.5 (95% CI, 9.8–29.5) in the control group and 7.6 (95% CI, 3.3–15.0) in the experimental group ( P < .05). Mortality rates were similar between both study groups: 31.5% in the control group versus 29.1% in the experimental group (adjusted RR, 0.93 [95% CI, 0.52–1.65]; P = .796). No severe adverse events related to oral care were observed during the study.
Conclusion
Dental treatment was safe and effective in the prevention of LRTI among critically ill patients who were expected to stay at least 48 hours in the ICU.
Trial registration
Brazilian Clinical Trials Registry, affiliated with the World Health Organization’s International Clinical Trial Registry Platform: U1111-1152-2671.
Infect Control Hosp Epidemiol 2014;35(11):1342–1348
Background:
Cardiac rehabilitation (CR) has been shown to provide the best social, psychological and physical conditions for patient recovery after myocardial infarction (MI).
Objectives:
The aim of present study was to quantify the efficacy of exercise-based CR treatments in terms of relief from symptoms of anxiety and depression symptoms among patients with MI.
Methods:
Literature published up to August 2017 was reviewed systematically using relevant keywords, MeSH terms, and Emtree headings to search PubMed, Embase, CINAHL (Ebsco), Cochrane Central Register of Controlled Trials (CENTRAL) and Web of Science. The results of included studies were compared meta-analytically.
Results:
We found that exercise-based CR had a significant effect on decreasing anxiety and depression scores. Furthermore, exercise-based CR may alleviate anxiety and depressive symptoms at different time periods.
Conclusions:
For patients with MI, exercise-based CR has been demonstrated to alleviate anxiety and depressive symptoms. These findings highlight CR as essential and beneficial for minimizing MI patient anxiety and depression during recovery.
Objective:
To summarize evidence regarding the effectiveness of using chlorhexidine for oral healthcare on patients in the intensive care unit for the prevention of nosocomial pneumonia and ventilator-associated pneumonia.
Methods:
This overview of systematic reviews was developed using articles found in PUBMED, Cochrane Library, LILACS, CRD, CINHAL, manual search and grey literature.
Results:
Of the total 16 systematic reviews, 14 included meta-analysis. Most of them were classified with high methodological quality. In seven systematic reviews, chlorhexidine was effective for prevention of nosocomial pneumonia and ventilator-associated pneumonia in adult population in cardiothoracic intensive care unit. The effectiveness was contradictory with other population patients in intensive care units.
Conclusion:
Chlorhexidine has proven to be effective for the prevention of NP among adult populations in cardiothoracic ICU. In ICUs with patients who have varied clinical-surgical conditions, the effectiveness of chlorhexidine for the prevention of PN and VAP was inconclusive.