Amylase In Bronchoalveolar Lavage As A Potential Marker Of Oropharyngeal-To-Pulmonary Aspiration

Tripathi, Abhishek; Mirant-Borde, Maria; Lee, Augustine

doi:10.1164/ajrccm-conference.2011.183.1_meetingabstracts.a4616

Cited by 6 publications

(8 citation statements)

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“…Additional modifications of our laboratory procedures to detect lower levels of amylase are warranted; however, the values we obtained were similar to those reported for patients receiving mechanical ventilation who had risk factors for aspiration and infections. 5,7,8 Our findings are consistent with those of other reports 5,6,[8][9][10][11][12]14,[26][27][28][29][30][31][32][33][34][35][36] of pepsin and amylase as biomarkers of microaspiration. Dewavrin and colleagues 36 argue that the use of amylase is only moderately accurate in diagnosing microaspiration.…”

Section: Discussionsupporting

confidence: 92%

Pepsin and Amylase in Oral and Tracheal Secretions: A Pilot Study

Sole¹,

Conrad²,

Bennett³

et al. 2014

American Journal of Critical Care

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worth, RN, MSN, CCRN, CCNS, and Devendra Indulal Mehta, MBBS, MSc(dist), MRCP Background Endotracheal intubation increases the risk for microaspiration of secretions around the tube cuff. Pepsin has been used as a biomarker for gastric aspiration. Amylase is a newer proposed biomarker for aspiration of oral contents. Objective To assess the presence of pepsin and amylase in paired oral-tracheal secretions of adult patients treated with mechanical ventilation. Methods In this descriptive study, paired samples of oral and tracheal secretions were obtained from adult patients at baseline and again within 4 hours when a need for endotracheal suctioning was assessed. Assays of pepsin and amylase were processed in a specialty diagnostic laboratory. Results The sample consisted of 10 men and 3 women with a median age of 56 years. The majority were intubated with a subglottic suction endotracheal tube (9 patients, 69%), receiving synchronized intermittent mandatory ventilation (10 patients; 77%), and receiving enteral feedings (11 patients; 85%) through a tube distally placed in the stomach (8 patients; 67%). Pepsin was present in oral secretions of 9 patients (69%), and in tracheal specimens of 7 patients (54%) at one or both sampling times. Amylase was detected in all patients' oral secretions and in tracheal secretions of 5 patients (38%) at one or both sampling times. Conclusions Many patients had pepsin, amylase, or both in tracheal aspirates. Pepsin was more commonly detected than was amylase. Although the relationship of this finding to longterm outcomes was not assessed, findings indicate that microaspiration of oral and gastric secretions occurs frequently.

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Section: Discussionsupporting

confidence: 92%

Pepsin and Amylase in Oral and Tracheal Secretions: A Pilot Study

Sole¹,

Conrad²,

Bennett³

et al. 2014

American Journal of Critical Care

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“…For example, a bronchoscope has to be introduced through the pharynx to access the lower airways, and based on studies of salivary amylase, bronchoscopy almost always induces some degree of oropharyngeal aspiration. 34,35 As such, pepsin in the lower airways may simply refl ect proximal refl ux (laryngopharyngeal refl ux). A second important consideration is that, unlike pepsinogen A, pepsinogen C has been identifi ed in extragastric 36 sites, including the lungs.…”

Section: Resultsmentioning

confidence: 99%

Airway Pepsin Levels in Otherwise Healthy Surgical Patients Receiving General Anesthesia With Endotracheal Intubation

Bohman

Kor

Kashyap

et al. 2013

Chest

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“…Alpha‐amylase is an enzyme that initiates the digestive process and is normally present in saliva and oral secretions but not in the lungs. Several researchers have identified α‐amylase in tracheal secretions, indicating microaspiration of oral contents (Abu‐Hasan, Elmallah, Neal, & Brookes, ; Dewavrin et al, ; Filloux et al, ; Qu et al, ; Samanta et al, ; Sole et al, ; Tripathi, Mirant‐Borde, & Lee, ; Weiss, Moazed, DiBardino, Swaroop, & Wunderink, ).…”

Section: Introductionmentioning

confidence: 99%

“…aspiration, aspiration biomarker, mechanical ventilation, nursing, pneumonia, ventilator associated events, α-amylase Filloux et al, 2013;Qu et al, 2018;Samanta et al, 2018;Sole et al, 2012;Tripathi, Mirant-Borde, & Lee, 2011;Weiss, Moazed, DiBardino, Swaroop, & Wunderink, 2013).…”

Section: Introductionmentioning

confidence: 99%

Impact of deep oropharyngeal suctioning on microaspiration, ventilator events, and clinical outcomes: A randomized clinical trial

Sole

Talbert

Yan

et al. 2019

Journal of Advanced Nursing

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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.

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Amylase In Bronchoalveolar Lavage As A Potential Marker Of Oropharyngeal-To-Pulmonary Aspiration

Cited by 6 publications

References 0 publications

Pepsin and Amylase in Oral and Tracheal Secretions: A Pilot Study

Pepsin and Amylase in Oral and Tracheal Secretions: A Pilot Study

Airway Pepsin Levels in Otherwise Healthy Surgical Patients Receiving General Anesthesia With Endotracheal Intubation

Impact of deep oropharyngeal suctioning on microaspiration, ventilator events, and clinical outcomes: A randomized clinical trial

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