Effect of an oral care bundle on salivary pH, dry mouth and ventilator-associated pneumonia in intubated patients: a randomized controlled trial
Makaleler > Tam Makale · 2026
Yazarlar: Gül Güneş Aktan, İsmet Eşer, Mehmet UYAR
BMC Oral Health, Uluslararası, Wos, 2026, cilt 26
DOI: 10.1186/s12903-026-08716-6
Özet
More serious and costly problems can be prevented with systematic and holistic oral care, which seems to be less important among nursing practices. To determine the effectiveness of oral care bundle on oral health, saliva volume, saliva pH and VAP in intubated patients. This randomized controlled trial data was collected between January and December 2021 in the Anesthesiology and Reanimation ICUs at a university hospital. Patients were randomly assigned to intervention and control groups. While routine oral care was applied to the control group (abeslang wrapped in gauze), the intervention group was given care with the oral care bundle created by the researchers (brushing teeth, applying ice water, moisturizing). The primary outcome was the oral health score (BOE), and the primary endpoint was defined as the BOE score at Day 5. Secondary outcomes included saliva volume, salivary pH, ventilator-associated pneumonia. Repeated measures were analyzed using two-way repeated measures ANOVA for normally distributed variables and the Brunner–Langer model for non-normally distributed data. A total of 35 patients were analyzed (intervention: n = 17; control: n = 18). A significant group × time interaction was observed for the BOE score (p < 0.001), indicating an improvement in oral health over time in the intervention group compared with the control group. Similarly, a significant group × time interaction was found for saliva volume (p < 0.001). For salivary pH, a statistically significant interaction was also observed (p < 0.001); however, these findings should be interpreted with caution due to the subjective nature of the measurement method. Although the incidence of VAP and bacterial growth tended to be lower in the intervention group, the differences were not statistically significant between groups. The intervention improved oral health outcomes in intubated ICU patients, particularly in terms of BOE score and saliva volume. However, findings related to salivary pH and VAP should be interpreted with caution due to methodological limitations and limited statistical power. Further studies with larger samples and more objective measurement methods are needed. The study has been retrospectively registered on clinicaltrials.gov (Clinical Trials ID: NCT06258603/05.02.2024). What is already known about this topic? • Intubated patients are at high risk of oral health deterioration. • Oral care practices in intensive care units are often routine-based rather than individualized. • Inadequate oral care may contribute to complications such as ventilator-associated pneumonia (VAP). What this paper adds? • Provides randomized controlled evidence that a structured oral care bundle improves oral health outcomes (including reduced dry mouth) in intubated ICU patients compared with routine care. • Suggests that oral care bundle (toothbrushing, cold/ice application, and moisturizing) may support salivary parameters, although findings for salivary pH should be interpreted cautiously due to measurement approach. • Contributes to the limited clinical evidence on comprehensive oral care protocols in mechanically ventilated patients and their potential role in preventing complications such as ventilator-associated pneumonia. How this study might affect research, practice or policy • Structured and individualized oral care bundles should be considered in the care of intubated patients. • These findings support the integration of evidence-based oral care protocols into intensive care nursing practice.