Glucose content of tracheal aspirates: Implications for the detection of tube feeding aspiration

Kinsey, Gail C.; Murray, M.; Swensen, Stephen J.; Miles, John M.

doi:10.1097/00003246-199410000-00009

Cited by 12 publications

(16 citation statements)

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“…At least two publications [21,22] have found frequent presence of glucose in endotracheal secretions, indicating aspiration of enteral feeding. However, this method has been seriously questioned by KINSEY et al [23], since they suggested that the concentration of glucose in tracheal secretions appears to be determined, in part, by ambient extracellular glucose concentrations. These authors concluded that measurement of glucose in tracheal secretions is unlikely to be useful in monitoring tube feeding aspiration in tracheally-intubated, enterally fed patients.…”

Section: Clinical Evidence For Gastric Aspiration To the Lower Airwaysmentioning

confidence: 99%

Stomach as a source of colonization of the respiratory tract during mechanical ventilation: association with ventilator-associated pneumonia

Torres

El-Ebiary²,

Soler³

et al. 1996

Eur Respir J

103

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The aetiopathogenesis of ventilator-associated pneumonia (VAP) requires abnormal oropharyngeal and gastric colonization and the further aspiration of their contents to the lower airways. VAP develops easily if aspiration or inoculation of microorganisms occur in patients with artificial airways, in whom mechanical, cellular and/or humoral defences are altered.Well-known risk factors for gastric colonization include: alterations in gastric juice secretion; alkalinization of gastric contents; administration of enteral nutrition; and the presence of bilirubin. However, the role of the colonized gastric reservoir in the development of VAP remains debatable.Evidence in favour of the role of the stomach in the development of VAP comes mainly from randomized, controlled trials of selective gut decontamination and stress ulcer prophylaxis in the intensive care unit (ICU), in which reducing the bacterial burden of the stomach decreases the incidence of nosocomial respiratory infections. However, at least three studies of flora have found an absence of stomach origin of pneumonia occurring during mechanical ventilation.Prophylactic measures suggested to prevent VAP in relation to the gastric reservoir include: treatment for stress ulcers with sucralfate; prevention of duodenal reflux with metoclopramide; reduction of gastric burden and bacterial translocation by selective digestive decontamination; acidification of enteral feeding; and jejunal feeding. Gastro-oesophageal reflux can be prevented by using small bore nasogastric tubes and jejunal feeding. The aspiration of gastric contents can be reduced by positioning patients in a semirecumbent position, checking the patency of the tube cuff, and aspiration of subglottic secretions.The role of the stomach as a reservoir for microorganisms causing ventilatorassociated pneumonia is still controversial but despite the debate, there is major evidence in the literature in favour of the gastric origin of part of these pulmonary infections.

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Section: Clinical Evidence For Gastric Aspiration To the Lower Airwaysmentioning

confidence: 99%

Stomach as a source of colonization of the respiratory tract during mechanical ventilation: association with ventilator-associated pneumonia

Torres

El-Ebiary²,

Soler³

et al. 1996

Eur Respir J

103

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“…Although aspiration from either source is important, the greatest concern in critically ill tube-fed patients is from tracheobronchial aspiration of gastric contents. The extent to which aspiration of gastric contents occurs is difficult to determine, primarily because most clinical studies have relied on flawed detection methods (Winterbauer et al 1981;Elpern et al 1986;Potts et al 1993;Kinsey et al 1994;Metheny et al 2002Metheny et al , 2005. Different animal models have been developed to investigate the mechanisms, characteristics, and pathophysiology of lung injury (Leth-Larsen et al 2003).…”

Section: Introductionmentioning

confidence: 99%

The effect of hyperbaric oxygen treatment on aspiration pneumonia

et al. 2011

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We have studied whether hyperbaric oxygen (HBO) prevents different pulmonary aspiration materials-induced lung injury in rats. The experiments were designed in 60 Sprague-Dawley rats, ranging in weight from 250 to 300 g, randomly allotted into one of six groups (n = 10): saline control, Biosorb Energy Plus (BIO), hydrochloric acid (HCl), saline + HBO treated, BIO + HBO treated, and HCl + HBO treated. Saline, BIO, HCl were injected into the lungs in a volume of 2 ml/kg. A total of seven HBO sessions were performed at 2,4 atm 100% oxygen for 90 min at 6-h intervals. Seven days later, rats were sacrificed, and both lungs in all groups were examined biochemically and histopathologically. Our findings show that HBO inhibits the inflammatory response reducing significantly (P < 0.05) peribronchial inflammatory cell infiltration, alveolar septal infiltration, alveolar edema, alveolar exudate, alveolar histiocytes, interstitial fibrosis, granuloma, and necrosis formation in different pulmonary aspiration models. Pulmonar aspiration significantly increased the tissue HP content, malondialdehyde (MDA) levels and decreased (P < 0.05) the antioxidant enzyme (SOD, GSH-Px) activities. HBO treatment significantly (P < 0.05) decreased the elevated tissue HP content, and MDA levels and prevented inhibition of SOD, and GSH-Px (P < 0.05) enzymes in the tissues. Furthermore, there is a significant reduction in the activity of inducible nitric oxide synthase, TUNEL and arise in the expression of surfactant protein D in lung tissue of different pulmonary aspiration models with HBO therapy. It was concluded that HBO treatment might be beneficial in lung injury, therefore, shows potential for clinical use.

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“…Although aspiration from either source is important, the type of greatest concern in critically ill tube-fed patients is tracheobronchial aspiration of gastric contents. The extent to which aspiration of gastric contents occurs is difficult to determine, primarily because most clinical studies have relied on flawed detection methods (such as observing tracheal secretions for dye-stained formula or glucose) (2)(3)(4)(5)(6)(7). Nonetheless, there is evidence that it is a formidable problem.…”

mentioning

confidence: 99%

Tracheobronchial aspiration of gastric contents in critically ill tube-fed patients: Frequency, outcomes, and risk factors

Metheny

Clouse

Chang

et al. 2006

Critical Care Medicine

332

240

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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. Keywords critical illness; enteral nutrition; aspiration pneumonia; risk factors; gastroesophageal reflux; gastric emptyingThe authors have no financial interests to disclose.The study was performed at Saint Louis University Hospital, in St. Louis, MO. NIH Public Access Author ManuscriptCrit Care Med. Author manuscript; available in PMC 2008 May 23. Published in final edited form as:Crit Care Med. 2006 April ; 34(4): 1007-1015. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author ManuscriptTracheobronchial aspiration can be defined as the inhalation of oropharyngeal or gastric contents into the respiratory tract (1). Although aspiration from either source is important, the type of greatest concern in critically ill tube-fed patients is tracheobronchial aspiration of gastric contents. The extent to which aspiration of gastric contents occurs is difficu...

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Glucose content of tracheal aspirates: Implications for the detection of tube feeding aspiration

Cited by 12 publications

References 0 publications

Stomach as a source of colonization of the respiratory tract during mechanical ventilation: association with ventilator-associated pneumonia

Stomach as a source of colonization of the respiratory tract during mechanical ventilation: association with ventilator-associated pneumonia

The effect of hyperbaric oxygen treatment on aspiration pneumonia

Tracheobronchial aspiration of gastric contents in critically ill tube-fed patients: Frequency, outcomes, and risk factors

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