Clinical Outcomes of Patients Undergoing Photodynamic Therapy in Intensive Care

Objectives: The objective of this study was to analyze the clinical outcomes of mechanically ventilated patients hospitalized in an intensive care unit (ICU) who received oral hygiene protocol with or without adjunct antimicrobial photodynamic therapy (aPDT).
Methods: Forty eligible patients, which orotracheal tubes, were randomized into two groups: 20 in the control group (oral hygiene using a toothbrush/swab and 0.12% chlorhexidine solution) and 20 in the experimental group (oral hygiene plus aPDT). Randomization was performed and the operator remained blinded until the aPDT procedure. aPDT was initiated on the first day of ICU admission and repeated every 48 hours, with the final session on day 7. Methylene blue was used as the photosensitizer in a lollipop-like format, allowing the operator to control and accurately stain the areas of interest. A 3-minute pre-irradiation time was followed by irradiation with a custom-designed LED light source consisting of three LEDs (36mW each), with two 60s of irradiation per area, covering the tongue, buccal mucosa, and palate. Clinical data, including age, sex, comorbidities, ICU stay duration, and mortality rates, were collected from patient medical records.
Results: The patient cohort had a mean age of 51 years, with 62% being male, and 80% presenting at least one comorbidity. SAPS scores, used to predict hospital mortality risk, were similar between the control (67.9 ± 20.6) and experimental groups (63.9 ± 13.5). However, ICU stay duration was significantly shorter in the experimental group (10.9 ± 15.9 days) compared to the control (15.7 ± 10.6 days) (p=0.013). Although mortality was lower in the experimental group (25% vs. 50%), the difference was not statistically significant (p=0.102).
Conclusions: These findings suggest potential clinical benefits of aPDT, including reduced ICU stay and a trend toward decreased mortality, supporting its adjunctive use in oral hygiene protocols for ICU patients.
This study was funded by FAPESP (#2023/09645-6).