Effect of Toothbrushing Without Chlorhexidine on Oral Hygiene Indices in Patients With Orotracheal Intubation

The oral hygiene method commonly used in intubated patients orotracheal is tooth brushing (mechanical removal) and washing the oral cavity and the orotracheal tube (TOT) with digluconate solution chlorhexidine (CLX). However, recent studies have demonstrated that the use of CLX in these conditions may expose the patient to a potential increased risk of mortality. Recent recommendations made by international bodies related to hospital biosafety no longer include the use of CLX in ICU oral hygiene routine. A question not yet answered in the literature is whether the absence of CLX in the critical patient's oral hygiene routine predisposes increased accumulation of dental plaque or microbial colonization related to the risk of systemic complications, such as pneumonia and sepsis. The cost-effectiveness of this protocol change also needs to be evaluated, as the withdrawal of CLX may result in changes in the risk profile morbidity and mortality during hospitalization. The present study aims to investigate whether brushing the oral cavity with mineral water changes the pattern of biofilm accumulation and clinical appearance of the oral mucosa in relation to brushing done with CLX. Microbiological analysis of the oropharyngeal biofilm and cost-effectiveness impact assessment will also be carried out.

Inclusion Criteria: * patients admitted to the adult ICU; * age over 18; * both sexes; * orotracheal intubation monitored from the first day; * absence of foci of infection in the oral cavity (periapical lesions, * periodontal abscesses, extensive cavities, opportunistic infections); * presence of at least five teeth per dental arch Exclusion Criteria: * patients in whom oral hygiene is not possible; * patients extubated before 24 hours from baseline; * patients with foci of infection in the oral cavity present in the baseline moment; * patients who died before 24 hours from baseline; * patients whose guardians do not authorize the research to be carried out; * patients whose information about oral and general health and other study variables are not available in the medical record, are doubtful or not capable of collection. * patients after heart surgery * patients with reintubation