Oral Care in Critically Ill Patients Requiring Noninvasive Ventilation: An Evidence-Based Review

Area of Science:

• Critical care nursing
• Infection prevention
• Respiratory therapy

Background:

• Hospital-acquired pneumonia (HAP) is a common complication, categorized as non-ventilator-acquired pneumonia (NV-AP) and ventilator-acquired pneumonia (VAP).
• While oral care bundles effectively reduce VAP, evidence for its use in non-ventilator-dependent patients, particularly those on noninvasive ventilation (NIV), is limited.
• NV-AP incidence is higher in NIV patients than the general hospitalized population, increasing mortality and length of stay.

Purpose of the Study:

• To review current evidence on oral care for critically ill patients requiring noninvasive ventilation.
• To inform nurses about the benefits and current gaps in oral care practices for NIV patients.

Main Methods:

• Literature review of studies on oral care interventions in critically ill patients.
• Analysis of existing data on NV-AP incidence and risk factors in NIV populations.
• Examination of current nursing practices and perceptions regarding oral care for non-intubated patients.

Main Results:

• No established standard of care for oral hygiene in NIV patients exists due to varied study findings and methodologies.
• Oral care is recognized for reducing HAP risk and enhancing patient comfort.
• Nurses may under-prioritize oral care for non-intubated patients, viewing it primarily as a comfort measure.

Conclusions:

• Oral care serves as a preventive measure for NV-AP and can improve patient comfort.
• Adherence to oral care protocols is lower in patients not on mechanical ventilation.
• Further research is essential to establish a standardized oral hygiene protocol for NIV patients and evaluate potential adverse events.