Tuesday, November 6, 2007

This presentation is part of : Critical Care Health Models
Developing a Method for Measuring Oral Dryness in Patients with an Endotracheal Tube
Janet S. Fulton, PhD and Onna Koeneman, BSN. Adult Health Department, Indiana University School of Nursing, Indianapolis, IN, USA
Learning Objective #1: describe complications associated with oral dryness in patients mechanically ventilated with and endotracheal tube.
Learning Objective #2: describe the results of a study that explored using the Modified Schirmer Test (MST) and oral pH as measures of oral dryness.

During mechanical ventilation, an ETT tube causes the mouth to remain open leading to drying of mucous membranes, resulting in inflammation and infection.  Problem:  Oral care is intended to keep the mouth healthy and moist; however, clinically useful outcome measures are not available to monitor the effectiveness of oral care in managing dryness.  Purpose:  This study (in progress) explored the relationship between oral pH and oral salivary flow as outcome indicators of oral dryness in patient who are mechanically ventilated through and endotracheal tube.  Framework:  Situation-specific theory guided  this study.  Methods:  This prospective study measured oral dryness in 30 subjects mechanically ventilated through and ETT.  Salivary flow was measured the Modified Schirmer Test (MST).  Oral pH was measured using the Universal pH indicator strips.  Measurements were taken two hours after oral care from four locations: vertically on the floor of the mouth, bilaterally horizontally on the inner cheek, and hard palate.  Three measures each of wetness and pH were obtained on each of two consecutive days for a total of six data points for each of the two types of measure. Analysis:  To explore relationship between salivary flow (MST) and pH as outcome measures of oral dryness, Pearson product-moment correlation will be calculated between the pH and MST obtained at each time point, stratified by location of the mouth.  Repeated measure ANOVA will explore overall association between the two measures at each location in the mouth.  Type of measures, measure time and interaction between type and time will be included as fixed effects.  A significant interaction in the model will be indicative of different correlation over time.  Findings and Implications:  The findings of this research will assist nurses to develop indicators to monitor the outcomes of oral care provided to patients who are mechanically ventilated using an ETT.