BACKGROUND: Because reflux of gastric juice into the oropharynx must precede its aspiration into the lungs, it is reasonable to hypothesize that the detection of pepsin (the major gastric enzyme in gastric juice) in oral secretions may provide a relatively noninvasive method of predicting risk for aspiration. OBJECTIVE: To describe the incidence of pepsin in oral and tracheal secretions collected concurrently from a sample of 50 gastric-fed patients undergoing mechanical ventilation. METHODS: An exploratory descriptive design with a convenience sample from 4 medical and surgical intensive care units. An oral secretion and a tracheal secretion were collected concurrently from each patient (yielding a sample of 50 oral and 50 tracheal secretions). The tracheal secretions were obtained via the inline suction system with an attached sputum trap; oral secretions were obtained via a Yankauer suction tip with an attached sputum trap. All specimens were assayed for pepsin by the Western blot method. RESULTS: Oral secretions from 10 patients (20%) and tracheal secretions from 2 patients (4%) were pepsin-positive. Both patients with pepsin-positive tracheal secretions also had pepsin-positive oral secretions. Pepsin was not found in the tracheal secretions from the remaining 8 patients with pepsin-positive oral secretions. CONCLUSIONS: Although reflux of gastric juice into the oropharynx must precede its aspiration into the lungs, individual reflux events do not necessarily lead to aspiration. Thus, it is reasonable that we found pepsin 5 times more often in oral secretions than in tracheal secretions.
BACKGROUND: Because reflux of gastric juice into the oropharynx must precede its aspiration into the lungs, it is reasonable to hypothesize that the detection of pepsin (the major gastric enzyme in gastric juice) in oral secretions may provide a relatively noninvasive method of predicting risk for aspiration. OBJECTIVE: To describe the incidence of pepsin in oral and tracheal secretions collected concurrently from a sample of 50 gastric-fed patients undergoing mechanical ventilation. METHODS: An exploratory descriptive design with a convenience sample from 4 medical and surgical intensive care units. An oral secretion and a tracheal secretion were collected concurrently from each patient (yielding a sample of 50 oral and 50 tracheal secretions). The tracheal secretions were obtained via the inline suction system with an attached sputum trap; oral secretions were obtained via a Yankauer suction tip with an attached sputum trap. All specimens were assayed for pepsin by the Western blot method. RESULTS: Oral secretions from 10 patients (20%) and tracheal secretions from 2 patients (4%) were pepsin-positive. Both patients with pepsin-positive tracheal secretions also had pepsin-positive oral secretions. Pepsin was not found in the tracheal secretions from the remaining 8 patients with pepsin-positive oral secretions. CONCLUSIONS: Although reflux of gastric juice into the oropharynx must precede its aspiration into the lungs, individual reflux events do not necessarily lead to aspiration. Thus, it is reasonable that we found pepsin 5 times more often in oral secretions than in tracheal secretions.
Authors: Norma A Metheny; Yie-Hwa Chang; Jing Song Ye; Sharon J Edwards; Julie Defer; Thomas E Dahms; Barbara J Stewart; Kathleen S Stone; Ray E Clouse Journal: Am J Crit Care Date: 2002-03 Impact factor: 2.228
Authors: Norma A Metheny; Thomas E Dahms; Yie-Hwa Chang; Barbara J Stewart; Patricia A Frank; Ray E Clouse Journal: JPEN J Parenter Enteral Nutr Date: 2004 Mar-Apr Impact factor: 4.016
Authors: A Torres; J Serra-Batlles; E Ros; C Piera; J Puig de la Bellacasa; A Cobos; F Lomeña; R Rodríguez-Roisin Journal: Ann Intern Med Date: 1992-04-01 Impact factor: 25.391
Authors: Sunitha Potluri; Frank Friedenberg; Henry P Parkman; Alan Chang; Robert MacNeal; Christopher Manus; Matthew Q Bromer; Aslam Malik; Robert S Fisher; Thomas Nugent; Vinod K Thangada; Friedrich Kueppers; Larry S Miller Journal: Dig Dis Sci Date: 2003-09 Impact factor: 3.199
Authors: M A Montecalvo; K A Steger; H W Farber; B F Smith; R C Dennis; G F Fitzpatrick; S D Pollack; T Z Korsberg; D H Birkett; E F Hirsch Journal: Crit Care Med Date: 1992-10 Impact factor: 7.598
Authors: Usha Krishnan; John D Mitchell; Isabella Messina; Andrew S Day; Timothy D Bohane Journal: J Pediatr Gastroenterol Nutr Date: 2002-09 Impact factor: 2.839
Authors: Steven Talbert; Annette M Bourgault; Kimberly Paige Rathbun; Bassam Abomoelak; Chirajyoti Deb; Devendra Mehta; Mary Lou Sole Journal: Am J Crit Care Date: 2021-11-01 Impact factor: 2.207
Authors: Juliana Coelho Pina; Suzana Alves de Moraes; Isabel Cristina Martins de Freitas; Débora Falleiros de Mello Journal: Rev Lat Am Enfermagem Date: 2017-05-22