Use of a clinical assessment tool for orally intubated patients

BACKGROUND: Although oral hygiene is difficult to perform in orally intubated, critically ill patients, oropharyngeal status may be related to acquisition of nosocomial organisms and should therefore be addressed. OBJECTIVE: To develop a clinical tool for assessment of the mouth in orally intubated patients. METHODS: Sixteen orally intubated patients from one surgical and one medical intensive care unit were subjects. Demographic, clinical, and baseline oropharyngeal assessment data, including sputum and mouth cultures, were obtained on patient admission to the study and every other day. RESULTS: Oropharyngeal cultures of four subjects grew nosocomial bacterial organisms and of two subjects, fungal species. These same organisms were cultured from sputum specimens. Seven patients displayed severe xerostomia; 10 lip lesions were identified in nine subjects, 8 tongue lesions in nine subjects, and 8 mucosal lesions in nine subjects. CONCLUSION: Systemic oropharyngeal assessment in critically ill orally intubated patients may prevent more serious oropharyngeal infections.