LAUSR

Intensive care unit (ICU) patients are fragile and highly subject to infections. Respiratory infections and especially ventilator-associated pneumonia (VAP) are the most frequent infectious complications in critically ill patients. Among the main measures to decrease VAP incidence, dental care is recommended in the prevention bundles. Aside from mouthwash with chlorhexidine, tooth brushing is widely used for VAP prevention in routine nursing practice even if its interest has not been fully demonstrated. It is well known that tooth brushing can cause transient bacteremia that are harmless for healthy individuals but can cause serious problems in critically ill patients. A 38-year old woman was admitted in the ICU with acute respiratory failure. Her main medical history was a mixed connective tissue disease (Sjögren’s syndrome) associated to natural killer (NK) cell deficiency. The Sjögren’s syndrome had been diagnosed seven years earlier because of strong clinical symptoms associated to positive anti-Ro, anti-La and anti-ribonucleoprotein (RNP) antibodies. The patient had then discontinued medical follow-up as she did not tolerate the treatments. At admission in the Emergency Department (ED) for serious dyspnea, she presented with acute respiratory failure and anasarca associated to a left ventricular dysfunction. An acute renal failure was biologically evidenced. The patient was directly transferred to the ICU where she was intubated and mechanically ventilated. Diagnostic assessment disclosed a type II cryoglobulinemia with consumption of the complement components and positive anti-Ro and anti-La antibodies. Renal biopsy showed Figure 1 A single-use suction toothbrush. This is a toothbrush that was tested in our unit. These toothbrushes are supposed to be more efficient removing dental plaque while being less traumatic. It sucks out debris and secretions very easily. The small sponge on the back enables cleaning and freshening up the mouth.