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

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

doi:10.1097/00003246-199422100-00009

Cited by 52 publications

(15 citation statements)

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“…In the absence of a sensitive and reliable bedside‐monitoring method, the recognition of aspiration is usually delayed until pulmonary distress becomes apparent (12). The two bedside methods, colouring the enteral formula and the detection of glucose in tracheal aspirates, are not sensitive and reliable in tracheally intubated and enterally fed patients (12–14). The modified barium swallow study to detect tracheobronchial aspiration is not suitable for critically ill patients and gastric scintiscans have proven insensitive (15–17).…”

Section: Introductionmentioning

confidence: 99%

Assessment of the prevalence of microaspiration by gastric pepsin in the airway of ventilated children

Gopalareddy¹,

He²,

Soundar³

et al. 2007

Acta Paediatrica

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Section: Introductionmentioning

confidence: 99%

Assessment of the prevalence of microaspiration by gastric pepsin in the airway of ventilated children

Gopalareddy¹,

He²,

Soundar³

et al. 2007

Acta Paediatrica

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“…Results from this study are clouded by the lack of sensitivity and specificity of the methods used to detect aspiration. 4,6,7,9,11 …”

Section: Discussionmentioning

confidence: 99%

Relationship Between Feeding Tube Site and Respiratory Outcomes

Metheny

Stewart

McClave

2011

J Parenter Enteral Nutr

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Background It is unclear if placing feeding tubes postpylorically to prevent respiratory complications is worth the extra effort. This study sought to determine the extent to which aspiration and pneumonia are associated with feeding site (controlling for the effects of severity of illness, degree of head-of-bed elevation, level of sedation, and use of gastric suction). Methods A retrospective analysis was performed on a large data set gathered prospectively to evaluate aspiration in critically ill, mechanically ventilated patients. Feeding site was designated by attending physicians and confirmed by radiography. Each patient participated in the study for 3 consecutive days, with pneumonia assessed by the simplified Clinical Pulmonary Infection Score on the fourth day. Tracheal secretions were assayed for pepsin in a research laboratory; the presence of pepsin served as a proxy for aspiration. A total of 428 patients were included in the regression analyses performed to address the research objectives. Results As compared with the stomach, the percentage of aspiration was 11.6% lower when feeding tubes were in the first portion of the duodenum, 13.2% lower when in the second/third portions of the duodenum, and 18.0% lower when in the fourth portion of the duodenum and beyond (all significant at P < .001). Pneumonia occurred less often when feedings were introduced at or beyond the second portion of the duodenum (P = .020). Conclusions The findings support feeding critically ill patients with numerous risk factors for aspiration in the mid-duodenum and beyond to reduce the risk of aspiration and associated pneumonia.

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“…In clinical practice the detection of aspiration of dye added to enteral feed has been shown to have poor sensitivity [10]. The addition of dye to gastric feed has been shown to have 13% sensitivity relative to a glucose oxidase test strip method [11], but this could be an underestimate because tracheal secretions can contain high glucose concentrations independent of enteral nutrition. Studies using small volumes of dye applied to the tongue have demonstrated low aspiration rates of 20% with HVLP cuffs [12].…”

Section: Discussionmentioning

confidence: 99%

Compliance characteristics of the Portex Soft Seal Cuff improves seal against leakage of fluid in a pig trachea model

Young

Blunt

1999

Crit Care

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Background: The Portex Soft Seal high-volume, low-pressure cuffed tracheal tube was compared with the Mallinckrodt HiLo, Sheridan Preformed and Portex Profile tracheal tubes for leakage of dye placed in the subglottic space of a pig's trachea which was used in a benchtop mechanical ventilation model and in six isolated pig tracheas. Results: There was no leakage, either in the ventilation model or in the isolated tracheas in the Portex Soft Seal group. There was rapid leakage in the ventilation model and in all the isolated tracheas for the Mallinckrodt HiLo, and five out of six isolated tracheas for the Sheridan Preformed and the Portex Profile group. Conclusions: This benchtop study suggests that the improved compliance characteristics of the Portex Soft Seal cuff are beneficial in preventing leakage of fluid in these models.

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

Cited by 52 publications

References 0 publications

Assessment of the prevalence of microaspiration by gastric pepsin in the airway of ventilated children

Assessment of the prevalence of microaspiration by gastric pepsin in the airway of ventilated children

Relationship Between Feeding Tube Site and Respiratory Outcomes

Compliance characteristics of the Portex Soft Seal Cuff improves seal against leakage of fluid in a pig trachea model

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