OBJECTIVES: To describe the frequency of pepsin-positive tracheal secretions (a proxy for the aspiration of gastric contents), outcomes associated with aspiration (including a positive Clinical Pulmonary Infection Score [a proxy for pneumonia] and use of hospital resources), and risk factors associated with aspiration and pneumonia in a population of critically ill tube-fed patients. DESIGN: Prospective descriptive study conducted over a 2-yr period. SETTING: Five intensive care units in a university-affiliated medical center with level I trauma status. PATIENTS: Each of the 360 adult patients participated for 4 days. Among the inclusion criteria were mechanical ventilation and tube feedings. An exclusion criterion was physician-diagnosed pneumonia at the time of enrollment. INTERVENTION: None. MEASUREMENTS AND MAJOR RESULTS: Almost 6,000 tracheal secretions collected during routine suctioning were assayed for pepsin; of these, 31.3% were positive. At least one aspiration event was identified in 88.9% (n = 320) of the participants. The incidence of pneumonia (as determined by the Clinical Pulmonary Infection Score) increased from 24% on day 1 to 48% on day 4. Patients with pneumonia on day 4 had a significantly higher percentage of pepsin-positive tracheal secretions than did those without pneumonia (42.2% vs. 21.1%, respectively; p < .001). Length of stay in the intensive care unit and need for ventilator support were significantly greater for patients with pneumonia (p < .01). A low backrest elevation was a risk factor for aspiration (p = .024) and pneumonia (p = .018). Other risk factors for aspiration included vomiting (p = .007), gastric feedings (p = .009), a Glasgow Coma Scale score <9 (p = .021), and gastroesophageal reflux disease (p = .033). The most significant independent risk factors for pneumonia were aspiration (p < .001), use of paralytic agents (p = .002), and a high sedation level (p = .039). CONCLUSIONS: Aspiration of gastric contents is common in critically ill tube-fed patients and is a major risk factor for pneumonia. Furthermore, it leads to greater use of hospital resources. Modifiable risk factors for aspiration need to be addressed.
OBJECTIVES: To describe the frequency of pepsin-positive tracheal secretions (a proxy for the aspiration of gastric contents), outcomes associated with aspiration (including a positive Clinical Pulmonary Infection Score [a proxy for pneumonia] and use of hospital resources), and risk factors associated with aspiration and pneumonia in a population of critically ill tube-fed patients. DESIGN: Prospective descriptive study conducted over a 2-yr period. SETTING: Five intensive care units in a university-affiliated medical center with level I trauma status. PATIENTS: Each of the 360 adult patients participated for 4 days. Among the inclusion criteria were mechanical ventilation and tube feedings. An exclusion criterion was physician-diagnosed pneumonia at the time of enrollment. INTERVENTION: None. MEASUREMENTS AND MAJOR RESULTS: Almost 6,000 tracheal secretions collected during routine suctioning were assayed for pepsin; of these, 31.3% were positive. At least one aspiration event was identified in 88.9% (n = 320) of the participants. The incidence of pneumonia (as determined by the Clinical Pulmonary Infection Score) increased from 24% on day 1 to 48% on day 4. Patients with pneumonia on day 4 had a significantly higher percentage of pepsin-positive tracheal secretions than did those without pneumonia (42.2% vs. 21.1%, respectively; p < .001). Length of stay in the intensive care unit and need for ventilator support were significantly greater for patients with pneumonia (p < .01). A low backrest elevation was a risk factor for aspiration (p = .024) and pneumonia (p = .018). Other risk factors for aspiration included vomiting (p = .007), gastric feedings (p = .009), a Glasgow Coma Scale score <9 (p = .021), and gastroesophageal reflux disease (p = .033). The most significant independent risk factors for pneumonia were aspiration (p < .001), use of paralytic agents (p = .002), and a high sedation level (p = .039). CONCLUSIONS: Aspiration of gastric contents is common in critically ill tube-fed patients and is a major risk factor for pneumonia. Furthermore, it leads to greater use of hospital resources. Modifiable risk factors for aspiration need to be addressed.
Authors: Stephen A McClave; Mark T DeMeo; Mark H DeLegge; James A DiSario; Daren K Heyland; James P Maloney; Norma A Metheny; Frederick A Moore; James S Scolapio; David A Spain; Gary P Zaloga Journal: JPEN J Parenter Enteral Nutr Date: 2002 Nov-Dec Impact factor: 4.016
Authors: Carlos M Luna; Daniel Blanzaco; Michael S Niederman; Walter Matarucco; Natalio C Baredes; Pablo Desmery; Fernando Palizas; Guillermo Menga; Fernando Rios; Carlos Apezteguia Journal: Crit Care Med Date: 2003-03 Impact factor: 7.598
Authors: O Akça; K Koltka; S Uzel; N Cakar; K Pembeci; M A Sayan; A S Tütüncü; S E Karakas; S Calangu; T Ozkan; F Esen; L Telci; D I Sessler; K Akpir Journal: Anesthesiology Date: 2000-09 Impact factor: 7.892
Authors: Norma A Metheny; Thomas E Dahms; Barbara J Stewart; Kathleen S Stone; Sharon J Edwards; Julie E Defer; Ray E Clouse Journal: Chest Date: 2002-07 Impact factor: 9.410