Significance of Mini Bronchoalveolar Lavage Fluid Amylase Level in Ventilator-Associated Pneumonia: A Prospective Observational Study*

Samanta, Sukhen; Poddar, Banani; Azim, Afzal; Singh, Rekha; Gurjar, Mohan; Baronia, Arvind Kumar

doi:10.1097/ccm.0000000000002774

Cited by 26 publications

(32 citation statements)

References 31 publications

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“…Much remains unknown regarding the prognostic ability α‐amylase in detecting microaspiration (Dewavrin et al, ; Qu et al, ; Samanta et al, ; Weiss et al, ). Filloux et al () reported that a cut‐off value of 1,832 U/L for tracheal amylase had a sensitivity of 88% and specificity of 100% for predicting microaspiration, yet the value that predicts clinical outcomes remains unknown.…”

Section: Discussionmentioning

confidence: 99%

“…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%

“…Weiss et al () reported that secretions obtained via bronchoalveolar lavage of ventilated patients were positive for α‐amylase within 72 hr after intubation. Levels of tracheal α‐amylase were higher in patients diagnosed with VAP using American Thoracic Society guidelines (Samanta et al, ).…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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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

View full text Add to dashboard Cite

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“…() found that increased tracheal aspirate α‐amylase levels were associated with preintubation aspiration risk factors. Alpha‐amylase levels were also significantly higher in VAP patients compared with non‐VAP patients (Qu et al., ; Samanta et al., ). When α‐amylase is detected in tracheal secretions, the amount detected in relation to the oral secretion value (tracheal/oral ratio) may also be a significant finding (Nandapalan et al., ); therefore, we are exploring changes in this ratio.…”

Section: Introductionmentioning

confidence: 99%

“…Standardized interventions have reduced incidences of VAP but do not fully address the risk factors (Rawat et al., ). Recognizing microaspiration in this population to reduce complications has been challenging; however, emerging evidence worldwide suggests α‐amylase may be indicative of microaspiration and/or VAP in the MV population (Dewavrin et al., ; Filloux et al., ; Qu et al., ; Samanta et al., ; Weiss, Moazed, Dibardino, Swaroop, & Wunderink, ; Weiss, Moazed, & Wunderink, ). Using α‐amylase as a biomarker, the targeted intervention proposed in this study to decrease microaspiration may significantly reduce harm.…”

Section: Introductionmentioning

confidence: 99%

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

Sole

Talbert

Yan

et al. 2019

Journal of Advanced Nursing

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Aim The primary aim of this study is to compare an oropharyngeal suction intervention versus usual care on microaspiration in intubated patients. Secondary aims are to evaluate the intervention on ventilator‐associated condition rates, time to occurrence and compare tracheal‐oral α‐amylase ratios between groups. Design Prospective randomized clinical trial. Methods The study received funding from the National Institutes of Health in February 2014 and Institutional Review Board approval in July 2013. Over 4 years, a convenience sample of 600 orally intubated, ventilated adult patients will be enrolled within 24 hr of intubation. The target sample is 400 participants randomized to the two groups. The intervention involves enhanced suctioning of the mouth and oropharynx every 4 hr, while the usual care group receives a sham suctioning. The research team will deliver usual oral care to all patients every 4 hr and collect oral and tracheal specimens every 12 hr, to quantify α‐amylase levels to detect aspiration of oral secretions. Study completers must be enrolled at least 36 hr (baseline and three paired samples). Outcomes include α‐amylase levels, percent of positive specimens, ventilator‐associated conditions, length of stay, ventilator hours, and discharge disposition. Discussion Enrolment has closed, and data analysis has begun. Subgroup analyses emerged, contributing to future research knowledge. Impact Standardized interventions have reduced but do not address all risk factors associated with ventilator‐associated conditions. This study provides the potential to reduce microaspiration and associated sequelae in critically ill, intubated patients.

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Using Bronchoalveolar Lavage to Evaluate Changes in Pulmonary Diseases

Yang

2020

Methods in Molecular Biology

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Significance of Mini Bronchoalveolar Lavage Fluid Amylase Level in Ventilator-Associated Pneumonia: A Prospective Observational Study*

Abstract: Patients with ventilator-associated pneumonia within 72 hours from intubation have significantly elevated α-amylase concentrations in mini bronchoalveolar lavage fluid. Mini bronchoalveolar lavage α-amylase concentrations increase with increasing number of aspiration risk factors.

Cited by 26 publications

References 31 publications

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

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

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

Using Bronchoalveolar Lavage to Evaluate Changes in Pulmonary Diseases

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