AIMS: To evaluate a deep oropharyngeal suction intervention (NO-ASPIRATE) in intubated patients on microaspiration, ventilator-associated events and clinical outcomes. DESIGN: Prospective, two-group, single-blind, randomized clinical trial. METHODS: The study was conducted between 2014 - 2017 in 513 participants enroled within 24 hr of intubation and randomized into NO-ASPIRATE or usual care groups. Standard oral care was provided to all participants every 4 hr and deep oropharyngeal suctioning was added to the NO-ASPIRATE group. Oral and tracheal specimens were obtained to quantify α-amylase as an aspiration biomarker. RESULTS: Data were analysed for 410 study completers enrolled at least 36 hr: NO-ASPIRATE (N = 206) and usual care (N = 204). Percent of tracheal specimens positive for α-amylase, mean tracheal α-amylase levels over time and ventilator-associated events were not different between groups. The NO-ASPIRATE group had a shorter hospital length of stay and a subgroup with moderate aspiration at baseline had significantly lower α-amylase levels across time. CONCLUSION:Hospital length of stay was shorter in the NO-ASPIRATE group and a subgroup of intervention participants had lower α-amylase across time. Delivery of standardized oral care to all participants may have been an intervention itself and possibly associated with the lack of significant findings for most outcomes. IMPACT: This trial compared usual care to oral care with a deep suctioning intervention on microaspiration and ventilator-associated events, as this has not been systematically studied. Further research on the usefulness of α-amylase as an aspiration biomarker and the role of oral suctioning, especially for certain populations, is indicated. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov: NCT02284178.
RCT Entities:
AIMS: To evaluate a deep oropharyngeal suction intervention (NO-ASPIRATE) in intubated patients on microaspiration, ventilator-associated events and clinical outcomes. DESIGN: Prospective, two-group, single-blind, randomized clinical trial. METHODS: The study was conducted between 2014 - 2017 in 513 participants enroled within 24 hr of intubation and randomized into NO-ASPIRATE or usual care groups. Standard oral care was provided to all participants every 4 hr and deep oropharyngeal suctioning was added to the NO-ASPIRATE group. Oral and tracheal specimens were obtained to quantify α-amylase as an aspiration biomarker. RESULTS: Data were analysed for 410 study completers enrolled at least 36 hr: NO-ASPIRATE (N = 206) and usual care (N = 204). Percent of tracheal specimens positive for α-amylase, mean tracheal α-amylase levels over time and ventilator-associated events were not different between groups. The NO-ASPIRATE group had a shorter hospital length of stay and a subgroup with moderate aspiration at baseline had significantly lower α-amylase levels across time. CONCLUSION: Hospital length of stay was shorter in the NO-ASPIRATE group and a subgroup of intervention participants had lower α-amylase across time. Delivery of standardized oral care to all participants may have been an intervention itself and possibly associated with the lack of significant findings for most outcomes. IMPACT: This trial compared usual care to oral care with a deep suctioning intervention on microaspiration and ventilator-associated events, as this has not been systematically studied. Further research on the usefulness of α-amylase as an aspiration biomarker and the role of oral suctioning, especially for certain populations, is indicated. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov: NCT02284178.
Authors: B Filloux; A Bedel; S Nseir; J Mathiaux; B Amadéo; B Clouzeau; J Pillot; T Saghi; F Vargas; G Hilbert; D Gruson; A Boyer Journal: Minerva Anestesiol Date: 2013-09 Impact factor: 3.051
Authors: Meyrick C M Chow; Shu-Man Kwok; Hing-Wah Luk; Jenny W H Law; Bartholomew P K Leung Journal: Int J Nurs Stud Date: 2012-06-28 Impact factor: 5.837
Authors: Michael Klompas; Yosef Khan; Kenneth Kleinman; R Scott Evans; James F Lloyd; Kurt Stevenson; Matthew Samore; Richard Platt Journal: PLoS One Date: 2011-03-22 Impact factor: 3.240
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: Steven Talbert; Christine Wargo Detrick; Kimberly Emery; Aurea Middleton; Bassam Abomoelak; Chirajyoti Deb; Devendra I Mehta; Mary Lou Sole Journal: Am J Crit Care Date: 2020-09-01 Impact factor: 2.228