Impact of deep oropharyngeal suctioning on microaspiration, ventilator events, and clinical outcomes: A randomized clinical trial.

AIMS: To evaluate a deep oropharyngeal suction intervention (NO-ASPIRATE) in intubated patients on microaspiration, ventilator-associated events and clinical outcomes. DESIGN: Prospective, two-group, single-blind, randomized clinical trial. METHODS: The study was conducted between 2014 - 2017 in 513 participants enroled within 24 hr of intubation and randomized into NO-ASPIRATE or usual care groups. Standard oral care was provided to all participants every 4 hr and deep oropharyngeal suctioning was added to the NO-ASPIRATE group. Oral and tracheal specimens were obtained to quantify α-amylase as an aspiration biomarker. RESULTS: Data were analysed for 410 study completers enrolled at least 36 hr: NO-ASPIRATE (N = 206) and usual care (N = 204). Percent of tracheal specimens positive for α-amylase, mean tracheal α-amylase levels over time and ventilator-associated events were not different between groups. The NO-ASPIRATE group had a shorter hospital length of stay and a subgroup with moderate aspiration at baseline had significantly lower α-amylase levels across time. CONCLUSION: Hospital length of stay was shorter in the NO-ASPIRATE group and a subgroup of intervention participants had lower α-amylase across time. Delivery of standardized oral care to all participants may have been an intervention itself and possibly associated with the lack of significant findings for most outcomes. IMPACT: This trial compared usual care to oral care with a deep suctioning intervention on microaspiration and ventilator-associated events, as this has not been systematically studied. Further research on the usefulness of α-amylase as an aspiration biomarker and the role of oral suctioning, especially for certain populations, is indicated. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov: NCT02284178.

Oral care practices in non-mechanically ventilated intensive care unit patients: An integrative review.

AIMS AND OBJECTIVES: To explore current oral care practices in nonmechanically ventilated ICU patients. BACKGROUND: Oral hygiene is an important aspect of nursing care in hospitalised populations. Oral care is a disease preventive and cost-effective measure for patients, particularly in ICU patients. Numerous studies support the value of oral care practices in mechanically ventilated ICU patients. Due to evidence supporting the benefits of oral care in nonmechanically ventilated patients, it would be beneficial to examine the literature for oral care practices in this population. METHODOLOGY: Literature searches of the following databases were performed: CINAHL Plus, MEDLINE, PsychInfo, Academic Search Premier, Cochrane Database of Systematic Reviews, and Web of Science. Three peer-reviewed articles were included in the review after inclusion criteria were applied. Findings were appraised, organised conceptually and synthesised using Torraco (2016b) as a guiding framework. Evidence was appraised using the Johns Hopkins Nursing Evidence-based Practice Rating Scale. PRISMA reporting guidelines were followed, when applicable. RESULTS: Findings support the existing gap in the literature of oral hygiene practices in nonmechanically ventilated ICU patients. Themes included the type of oral care products used, frequencies of oral care, documented oral care practices and personnel that performed the care. STUDY IMPLICATIONS: This integrative review identified an important gap in the literature for oral care practices in nonmechanically ventilated ICU patient populations. Further research on current oral care practices and development of evidence-based guidelines for this population are recommended. RELEVANCE TO CLINICAL PRACTICE: Nurses should provide oral care to all hospitalised patients and follow oral care guidelines specific to their population, if available.

Nursing oral suction intervention to reduce aspiration and ventilator events (NO-ASPIRATE): A randomized clinical trial.

AIM: The primary aim of this study is to compare an oropharyngeal suction intervention versus usual care on microaspiration in intubated patients. Secondary aims are to evaluate the intervention on ventilator-associated condition rates, time to occurrence and compare tracheal-oral α-amylase ratios between groups. DESIGN: Prospective randomized clinical trial. METHODS: The study received funding from the National Institutes of Health in February 2014 and Institutional Review Board approval in July 2013. Over 4 years, a convenience sample of 600 orally intubated, ventilated adult patients will be enrolled within 24 hr of intubation. The target sample is 400 participants randomized to the two groups. The intervention involves enhanced suctioning of the mouth and oropharynx every 4 hr, while the usual care group receives a sham suctioning. The research team will deliver usual oral care to all patients every 4 hr and collect oral and tracheal specimens every 12 hr, to quantify α-amylase levels to detect aspiration of oral secretions. Study completers must be enrolled at least 36 hr (baseline and three paired samples). Outcomes include α-amylase levels, percent of positive specimens, ventilator-associated conditions, length of stay, ventilator hours, and discharge disposition. DISCUSSION: Enrolment has closed, and data analysis has begun. Subgroup analyses emerged, contributing to future research knowledge. IMPACT: Standardized interventions have reduced but do not address all risk factors associated with ventilator-associated conditions. This study provides the potential to reduce microaspiration and associated sequelae in critically ill, intubated patients.