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Physiologic Factors Contributing to a Transition in Oral Immunity among Mechanically Ventilated Adults

Division Chair of Nursing and Health Sciences, 419 College Drive, Gordon College, University System of Georgia, Barnesville, GA 30204; phone: (770) 358-5085; fax: (770) 358-5064poneal{at}falcon.gdn.peachnet.edu

Nicole Brown, MM, MS

Cindy Munro, PhD, RN, ANP

Adult Health Nursing Department, School of Nursing at Virginia Commonwealth University

Ventilator-associated pneumonia (VAP), a specific type of nosocomial pneumonia, occurs in approximately 21% of patients in intensive care, and the mortality can be as high as 71%. VAP causes considerable mortality and morbidity, and it exponentially increases health care costs. The incidence of VAP is associated with oropharyngeal colonization of gram-negative bacteria. Within 48 h of hospital admission, the composition of the oropharyngeal flora of critically ill patients undergoes a change fromthe usual gram-positive streptococci and dental pathogens to a predominant gram-negative flora that includes more virulent organisms, which predispose patients to VAP. Identification and understanding of this oral transition from gram-positive to predominantly gram-negative flora may assist health care professionals in differentiating among oral immune markers that suggest compromised immunity. The purpose of this article is to provide a review of the literature that promotes an understanding of current knowledge about the transition of oral immunity in mechanically ventilated patients.

Key Words: Ventilator-associated pneumonia • nosocomial pneumonia • oral immunity • immune system • oral secretions • mechanical ventilation

Biological Research For Nursing, Vol. 3, No. 3, 132-139 (2002)
DOI: 10.1177/1099800402003003003


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