Oral clinical findings and intensive care unit prognostic scores.

OBJECTIVE: Hospitalisation in intensive care unit (ICU) may cause changes in oral environment, which may influence patients' health status. The aim of this study was to evaluate the frequency of intraoral and extraoral findings observed during ICU admission, and to verify if there is an association with clinical prognosis scores. METHODS: Data regarding clinical characteristics of patients hospitalised in an ICU were collected from medical records. The prognostic scores Sepsis Related Organ Failure Assessment (SOFA) and Simplified Acute Physiology Score (SAPS 3) were estimated with data collected from admission and SOFA on the day of the oral examination as well. Data on oral mucosa lesions, saliva, dental condition and oral hygiene were evaluated during oral examinations. RESULTS: The association of oral findings with prognostic scores was statistically verified. The majority (92.2%) of the 170 evaluated patients showed extraoral or intraoral findings during ICU admission. The most frequent findings were chapped and crusted lips, coated tongue, pale mucosa, haemorrhagic lesions, candidiasis, depapillated tongue and traumatic lesions. There were significant higher prognostic scores in the presence of the following extraoral and intraoral findings: crusted and ulcerated lips, haemorrhagic lesions, jaundice, spontaneous oral bleeding, coated and depapillated tongue. Median SAPS 3 was higher in patients with poor oral hygiene. CONCLUSIONS: Oral findings were frequent in the population of patients hospitalised in the ICU and some of them were associated with worse prognostic scores. Routine oral examinations must be performed in hospitalised patients from ICUs for detection of oral markers of worse clinical prognosis.

Oral health status of patients in intensive care unit: a cross-sectional study

Introduction: Patients in intensive care unit (ICU) may present oral alterations asa result of patients' systemic conditions, the use of medications, intubation orpoor oral hygiene. Oral alterations should be detected and treated because theymay aggravate patients' condition. The objective of this study was to evaluate thetypes and frequencies of clinically detected oral alterations in inpatients of an ICU.Methods: This is a cross-sectional study in which an oral evaluation of patientshospitalized in an ICU of a public hospital was performed. Demographic, socialand clinical characteristics were collected from medical records. Oral examswere performed by two trained dentists, with reliability checked by intra-classcorrelation coefficient, while patients were lying in the hospital bed, using a frontalheadlamp, tongue depressor and sterile gauze. All data were recorded in studyprotocol forms and transferred to a data base for analysis. Results: Thirty-sevenpatients, with similar distribution between genders, withmedian age of 62 yearswere evaluated. The most frequent causes for hospitalization were postoperativecare (51.35%) and respiratory problems (29.72%). About 90% of the inpatientspresented some type of oral alterations during the hospitalization period. Themost common clinical alterations were dry lips (86.5%); coated tongue (61.1%);paleness of the oral mucosa (54.1%); oral foci of infection (37.8%) and candidiasis(13.5%). Conclusion: The majority of inpatients of the ICU presented some type oforal alteration, and the most frequent were dry lips and coated tongue. Dataobserved in this study reinforce the need of the dental team support during theperiod of hospitalization.

Introdução: Pacientes em unidade de terapia intensiva (UTI) podem apresentaralterações orais como resultado das condições sistêmicas dos pacientes, uso demedicamentos, intubação ou falta de higiene bucal. Alterações orais devem serdetectadas e tratadas, pois podem agravar a condição do paciente. O objetivodeste estudo foi avaliar os tipos e frequências de alterações orais clinicamentedetectadas em pacientes internados em uma UTI. Métodos: Estudo transversalem que foi realizada avaliação oral de pacientes internados em uma UTI de umhospital público. Características demográficas, sociais e clínicas foram coletadasdos prontuários médicos. Os exames orais foram realizados por dois dentistastreinados, com confiabilidade verificada pelo coeficiente de correlação intra-classe, enquanto os pacientes estavam deitados na cama do hospital, utilizandofrontal, abaixador de língua e gaze estéril. Todos os dados foram registrados emformulários de protocolo do estudo e transferidos para uma base de dados paraanálise. Resultados: Foram avaliados 37 pacientes, com distribuição semelhanteentre os sexos, com mediana de idade de 62 anos. As causas mais frequentes deinternação foram cuidados pós-operatórios (51,35%) e problemas respiratórios(29,72%). Cerca de 90% dos pacientes internados apresentaram algum tipo dealteração bucal durante o período de internação. As alterações clínicas maiscomuns foram lábios secos (86,5%); língua (61,1%); palidez da mucosa oral (54,1%);focos orais de infecção (37,8%) e candidíase (13,5%). Conclusão: A maioria dospacientes internados em UTI apresentou algum tipo de alteração oral, sendo osmais frequentes lábios secos e língua. Os dados observados neste estudo reforçama necessidade do apoio da equipe odontológica durante o período de internação.

Investigação de candidíase oral em pacientes internados em uma unidade de terapia intensiva e relação com dados clínicos e de prognóstico / Investigation of oral candidase in patients inside a unit intensive therapy and relationship with clinical data and prognosis

A candidíase oral é uma infecção fúngica oportunista muito prevalente em pacientes internados em unidades de terapia intensiva (UTIs). O presente estudo teve como objetivo avaliar a frequência de candidíase oral em pacientes internados na UTI de um hospital público do Rio de Janeiro, relacionando-a com dados clínicos, desfecho da hospitalização e índices de prognóstico. Caracterizou-se por ser um estudo transversal observacional. Os dados demográficos e clínicos foram coletados dos prontuários médicos e os pacientes avaliados através de exame físico oral. Esfregaços do dorso da língua e das mucosas jugal e labial também foram coletados para realização de exame citopatológico. A qualidade da higiene oral dos pacientes também foi avaliada. Cento e quarenta e nove pacientes foram avaliados, igualmente distribuídos entre gêneros, com mediana da idade de 60 anos. O tempo de internação variou de 1 a 39 dias, sendo que 83,9% sobreviveram à internação na UTI. A prevalência de candidíase oral, nestes pacientes, detectada clinicamente foi de 14,8%, enquanto que no exame citopatológico, o resultado foi positivo para 26,2% (língua) e 18,8% (outras áreas). Em 61,7% a qualidade da higiene foi classificada como regular ou ruim. Os índices de prognóstico SAPS 3 e SOFA foram menores quando relacionados à presença de candidíase oral detectada clinicamente. Já quanto à análise citopatológica, os índices foram maiores quando relacionados a exames positivos para candidíase. Além disso, a citopatologia da língua foi negativa na maioria (64%) dos pacientes que sobreviveram. A candidíase oral detectada através do exame citopatológico representou um marcador de prognóstico clínico para pacientes internados em UTI.(AU)

Oral candidiasis is a prevalent fungal opportunistic infection in patients admitted to intensive care units (ICUs). The study evaluated the frequency of oral candidiasis in patients admitted to the ICU of a public hospital in Rio de Janeiro, and the relationship to clinical characteristics, hospitalization outcome and prognostic scores. This was a cross-sectional observational study. Demographic and clinical data were collected from medical records and patients received an oral exam. Smears were performed on the dorsum of the tongue, labial and buccal mucosa for cytopathological examination. The oral hygiene quality of the patients was also evaluated. One hundred and forty nine patients were evaluated, equally distributed among genders, with a median age of 60 years. The length of stay in the ICU varied from 1 to 39 days, and 83.9% survived ICU admission. Clinically detected oral candidiasis was observed in 14.8% of patients, while the cytopathological examination was positive in 26.2% (tongue) and 18.8% (other sites) of patients. In 61.7% of the patients, the hygiene was classified as regular or poor. The SAPS 3 and SOFA prognostic scores were lower when candidiasis was clinically observed. Patients showed worse prognostic scores when cytopathology was positive for candidiasis. Cytopathology of the tongue was negative for the majority (64%) of the patients who survived. Candidiasis detected through the cytopathological exam may represent a clinical prognostic marker for patients during hospitalization in the ICU. (AU)