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

Abstract

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.

Immunoserologic Pepsin Detection in The Saliva as a Non-Invasive Rapid Diagnostic Test for Laryngopharyngeal Reflux

“…Pepsin can be found in many different tissue samples such as laryngeal mucosa, paranasal sinus mucosa, saliva, middle ear effusion, tracheal secretions and bronchoalveolar lavage fluid (9)(10)(11). It is a large molecule; therefore, it can be easily detected after gastric reflux.…”

Nursing oral suction intervention to reduce aspiration and ventilator events (NO‐ASPIRATE): A randomized clinical trial

“…We have observed that patients may awaken during oral care interventions, but they fall back to sleep immediately after it is done. We have performed this procedure (NO‐ASPIRATE) to obtain specimens in previous studies without any adverse issues, such as gagging or oral trauma (Sole, Bennett, et al., ; Sole, Marano, et al., ; Sole, Middleton, et al., ; Sole, Talbert, et al., ). However, participant response will be observed as part of ongoing monitoring.…”

“…Suctioning will be done using standard suction pressures until secretions are no longer audible or visible, for a duration of about 45 s (Chulay & Seckel, ; Sole, Bennett, et al., ). We performed this procedure in previous studies without any adverse issues, such as gagging or oral trauma (Sole, Bennett, et al., ; Sole, Marano, et al., ; Sole, Middleton, et al., ; Sole, Talbert, et al., ). However, participant response will be observed and the procedure will be stopped if intolerance is noted.…”

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

“…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, ).…”