North American Summit on Aspiration in the Critically Ill Patient: Consensus Statement

Abstract

Aspiration is the leading cause of pneumonia in the intensive care unit and the most serious complication of enteral tube feeding (ETF). Although aspiration is common, the clinical consequences are variable because of differences in nature of the aspirated material and individual host responses. A number of defense mechanisms normally present in the upper aerodigestive system that protect against aspiration become compromised by clinical events that occur frequently in the critical care setting, subjecting the patient to increased risk. The true incidence of aspiration has been difficult to determine in the past because of vague definitions, poor assessment monitors, and varying levels of clinical recognition. Standardization of terminology is an important step in helping to define the problem, design appropriate research studies, and develop strategies to reduce risk. Traditional clinical monitors of glucose oxidase strips and blue food coloring (BFC) should no longer be used. A modified approach to use of gastric residual volumes and identification of clinical factors that predispose to aspiration allow for risk stratification and an algorhythm approach to the management of the critically ill patient on ETF. Although the patient with confirmed aspiration should be monitored for clinical consequences and receive supportive pulmonary care, ETF may be continued when accompanied by appropriate steps to reduce risk of further aspiration. Management strategies for treating aspiration pneumonia are based on degree of diagnostic certainty, time of onset, and host factors.

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016

“…The rationale for measurement of GRVs is to reduce the risk for aspiration pneumonia by either ceasing or modifying the enteral feeding strategy based on the detection of excess gastric residuals. The inherent controversy is that observational and interventional studies have not consistently confirmed a relationship between the measurement of GRVs (with thresholds ranging from 200 mL to no monitoring of GRVs) and outcomes of vomiting, aspiration, or pneumonia [597][598][599][600][601][602][603]. In our systematic review, we identified one multicenter non-inferiority trial of 452 critically ill patients who were randomized to not monitoring GRVs versus monitoring GRVs at 6-h intervals [602].…”

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

“…Adequate numbers to make comparisons between groups were attained only with the 30-degree cut-point. Because published guidelines to prevent aspiration and pneumonia call for head-ofbed elevation to at least 30 degrees (16,17), this value was used to make group comparisons. As shown in Table 8, a mean backrest elevation <30 degrees occurred more often in the highaspiration group than in the low-aspiration group (67.6% vs. 56.0%, respectively; p = .024).…”

Determinación del volumen gástrico residual: en busca de la mejor evidencia

“…Este proceso dio como resultado una supresión por repetición de casi un 30% de los trabajos; y finalmente se listaron 29 artículos a localizar en texto completo 6,11,14, .…”

“…McClave et al 14 presentan una exhaustiva revisión acerca del problema de la aspiración en las poblaciones de paciente crítico, y entre otros temas abordan la relación con el VGR y recomiendan la reintroducción del contenido aspirado en pacientes portadores de nutrición enteral 14 .…”

“…La elección de una u otra intervención, reintroducción o desecho, se basa en supuestas hipótesis fisiopatológicas no testadas, en opiniones de expertos, en la experiencia individual de cada enfermera o en la «tradición» del servicio («aquí siempre se ha hecho así») 6,14 .…”