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Pepsin as a marker for pulmonary aspiration
Norma A Metheny1, Yie-Hwa Chang, Jing Song Ye
1School of Nursing, St Louis University, Mo, USA.
Summary
A pepsin immunoassay can detect gastric aspiration in mechanically ventilated patients. A flat head-of-bed position significantly increases the risk of aspiration, as indicated by pepsin in tracheal secretions.
Area of Science:
- Critical Care Medicine
- Gastroenterology
- Pulmonary Medicine
Background:
- Assessing gastric content aspiration in tube-fed, mechanically ventilated patients is crucial but challenging.
- Current methods for detecting aspiration are not optimal.
- Pepsin immunoassay in tracheal secretions offers a potential diagnostic approach.
Purpose of the Study:
- To evaluate the frequency of detecting pepsin in tracheal secretions using immunoassay.
- To assess the utility of pepsin immunoassay for identifying gastric aspiration in critically ill patients.
Main Methods:
- Collected 136 tracheal secretion specimens from 30 tube-fed, mechanically ventilated adults.
- Utilized an immunoassay with polyclonal antibodies to detect human pepsin.
- Analyzed specimens for pepsin presence and correlated findings with patient positioning.
Main Results:
- Pepsin was detected in 14 specimens from 5 patients.
- A strong association (P<.001) was found between a flat head-of-bed position and pepsin presence.
- 92.9% of pepsin-positive specimens were from patients in a flat position.
Conclusions:
- Pepsin immunoassay is a viable method for detecting pepsin in human tracheal secretions.
- Findings suggest aspiration occurred in 5 of 30 subjects, indicated by tracheal pepsin.
- Maintaining an elevated head-of-bed position is critical to reduce aspiration risk.