Contribuição da Odontologia na rotina assistencial em UTI

• Ano de defesa: 2019
• Autor(a) principal: SOUZA, Luana Carneiro Diniz
• Orientador(a): LOPES, Fernanda Ferreira
• Banca de defesa: CRUZ , Maria Carmen Fontoura Nogueira da , CORRÊA , Rita da Graça Carvalhal Frazão , CALVET , Clélea de Oliveira , SILVA , Maria do Socorro Alves Cardoso da , LOPES, Fernanda Ferreira
• Tipo de documento: Tese
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade Federal do Maranhão
• Programa de Pós-Graduação: PROGRAMA DE PÓS-GRADUAÇÃO EM ODONTOLOGIA/CCBS
• Departamento: DEPARTAMENTO DE ODONTOLOGIA II/CCBS
• País: Brasil
• Palavras-chave em Português: Unidade de Terapia Intensiva; Pneumonia associada a ventilação mecânica; Assistência odontológica; Pacotes de assistência ao paciente; Cuidados críticos; Saúde bucal
• Palavras-chave em Inglês: ICU; Pneumonia; Ventilator-associated; Dental care; Patient care bundles; Critical care; Oral health
• Área do conhecimento CNPq: Odontologia
• Link de acesso: https://tedebc.ufma.br/jspui/handle/tede/tede/2687

Patients admitted to the Intensive Care Unit (ICU) present changes in their oral microbiota, which after 48 hours of hospitalization begin to present respiratory pathogens that can be aspirated, thus causing nosocomial pneumonia. This microbial load is increased in the presence of periodontal and fungal infections, commonly found in the critical patient, whose treatment has relevant potential in the prevention of respiratory infections, although there are studies on their reduction and oral hygiene protocols, few report the actions of the Dental Surgeon inserted in the ICU multiprofessional team. Thus, we aimed to chapter I the effectiveness of the Dentistry service and its technical efficiency in hospital indicators in Adult ICU and chapter II, to present the efficacy and effectiveness of the Dentistry’s actions through an oral health care package of patients under mechanical ventilation (MV), as well as their correlation with ventilator-associated pneumonia (VAP). Chapter I is a health service evaluation survey, with a quantitative approach, in the General ICU dentistry service of the University Hospital of the Federal University of Maranhão (HUUFMA). The planning, objectives, indicators and characteristics of this service are presented. Collection of hospital indicators: Incidence and Density of PAV, Mechanical Ventilation Rate (MV / day), Mean of patients / day, Length of stay, Mortality rate, Occupancy rate, Bed / day installed, Number of transfers in the previous period in which there was no dental care in the ICU in question and in the period after the insertion of this assistance. Aiming to compare the frequencies of these indicators in the ICU in the periods before and after the performance of the dental professional. As results, it was found that in the 18 months prior to the inclusion of the Dentist in the General ICU, 53 cases of VAP were reported, and in the following 18 months, Dentist, there were 44 cases, demonstrating the reduction of the VAP incidence and density. There was a mean decrease from 2.94 (± 1.51) to 2.44 (± 1.14) cases of VAP. In the periods after the dental care insertion, there was a significant reduction in the MV / day rate, as well as a significant increase in the amount of bed / day installed and the transfers. There was also a reduction in the mortality rate and occupancy rate. A mean of 91.11% of the general dental admission rate and 100% of the patients in MV were observed. An average of 97.63% of the daily oral supervision rate of VM/ day beds. Based on the data presented, we conclude that the ICU dentistry service can contribute to the reduction of mechanical ventilation days, which may have an impact on the reduction of VAP and consequent increase in bed rotation and decrease in hospital deaths and costs. In Chapter II, this is a retrospective, descriptive and quantitative-based longitudinal study developed at the General ICU of HUUFMA, from April to December 2013, in which a dental care package was applied within the PAV Prevention Bundle. Collection of data from the PAV bundle items as well as the patients' oral condition. A total of 146 patients were followed daily, following the routine of surveillance of all PAV bundle items. It was observed that the rate of adherence to oral hygiene reached 90.99%, other bundle items remained with the adhesion of 88.36 to 98.27% and an average of 38.99% for joint adhesion to all the items. In the patients who developed VAP, there was a lower percentage of satisfactory oral hygiene (45.24%), as well as a higher percentage of lingual biofilm (45.24%). The percentage of satisfactory oral hygiene at admission and the VAP incidence presented a negative correlation. It was shown that the inclusion of Dentistry in the VAP prevention protocol, allowed a satisfactory oral condition during hospitalization, as well as an increase in the adherence of nursing teams to oral hygiene, which reflected lower PAV rates. We conclude that the ICU Dentistry service through its care routine contributed to the maintenance of the patients' oral health during hospitalization, in the VAP prevention protocol, which reflected in the reduction of mechanical ventilation days, lower rates of VAP, with consequent increased bed availability, decreased deaths and hospital costs.