Effect of Toothbrushing Without Chlorhexidine on Oral Hygiene Indices in Patients With Orotracheal Intubation

• Chlorhexidine group: Oral hygiene will be carried out in accordance with the standard operating procedures already carried out for all patients admitted to the ICU. First, the secretion contained in the oral cavity will be aspirated with a suction probe or a dental sucker or the suction brush itself before starting the oral hygiene procedure. The hygiene process will begin by moistening the oral cavity, using non-sterile gauze soaked in filtered mineral water and applying it to the entire oral mucosa. Subsequently, the sucking toothbrush or oral swab should be moistened frequently with 0.12% chlorhexidine digluconate solution and proceed with cleaning the dental surfaces on their buccal, palatal and occlusal surfaces, moving towards the oral cavity and tongue, using the bristle part of the toothbrush; With the region opposite the dental bristles or oral swab, the 0.12% chlorhexidine solution will be applied to the oral mucosa, palate, tongue dorsum and orotracheal tube, always performing a postero-anterior movement and removing any dirt with the aid of moistened gauze . The oral cavity will be constantly vacuumed throughout the oral hygiene procedure. Finally, the lips will be lubricated with a standardized lip moisturizer. The procedure will be carried out every 8 hours, that is, three times a day.
• Water group: The intervention group procedure will be carried out in the same way and frequency as the control group, however, replacing the 0.12% chlorhexidine solution with mineral water. Oral hygiene will be carried out by the nursing team, who will be blind to the indices to be evaluated. The team will be previously trained to carry out hygiene procedures by the ICU team of dental surgeons.

Inclusion criteria

• patients admitted to the adult ICU;
• age over 18;
• both sexes;
• orotracheal intubation monitored from the first day;
• absence of foci of infection in the oral cavity (periapical lesions,
• periodontal abscesses, extensive cavities, opportunistic infections);
• presence of at least five teeth per dental arch

Exclusion criteria

• patients in whom oral hygiene is not possible;
• patients extubated before 24 hours from baseline;
• patients with foci of infection in the oral cavity present in the baseline moment;
• patients who died before 24 hours from baseline;
• patients whose guardians do not authorize the research to be carried out;
• patients whose information about oral and general health and other study variables are not available in the medical record, are doubtful or not capable of collection.
• patients after heart surgery
• patients with reintubation