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Risk of pulmonary aspiration among patients receiving enteral nutrition support
H Mullan1, R A Roubenoff, R Roubenoff
1Department of Nutrition, Johns Hopkins Hospital, Baltimore, Maryland.
Insights
Pulmonary aspiration is uncommon and generally benign in tube-fed adults. Risk factors include older age and ward location, suggesting prevention is possible with good nursing care.
Area of Science:
- Clinical Medicine
- Gastroenterology
- Critical Care
Background:
- Pulmonary aspiration is a concern in patients receiving enteral nutrition.
- Understanding its incidence and risk factors is crucial for patient care.
Purpose of the Study:
- To determine the prevalence, incidence, and risk factors of pulmonary aspiration in adult tube-fed patients.
- To assess the morbidity and mortality associated with aspiration events.
Main Methods:
- Retrospective analysis of adult patients receiving tube feeding over six months.
- Data collection on aspiration events, patient demographics, location, and outcomes.
Main Results:
- Prevalence was 4.4% (12 events in 276 patients); incidence was 2.4 per 1000 tube-feeding days.
- Major risk factors identified were older age and hospital ward location versus intensive care units.
- No excess mortality or significant morbidity was directly linked to aspiration.
Conclusions:
- Pulmonary aspiration is uncommon and typically benign in enterally fed patients.
- Aspiration is more frequent on wards than in ICUs, indicating preventability with nursing care.
- Fear of aspiration should not preclude enteral nutrition in acutely ill patients.
Abstract:
We investigated the prevalence, incidence, and risk factors for pulmonary aspiration in all tube-fed adult patients over 6 months. Twelve aspiration events occurred among 276 patients (prevalence, 4.4%; 95% confidence interval, 2.2% to 7.6%). The incidence of aspiration was 2.4 per 1000 tube-feeding days (95% confidence interval, 1.2 to 3.9 per 1000). Despite 17% overall mortality, there was no excess mortality and little morbidity associated with aspiration. The major risk factors for aspiration were patient age (p less than .015) and location in the hospital (p less than .008): the probability of aspiration in the intensive care units (n = 113) was 0.9% compared with 4.9% on medical or surgical wards (n = 142), 16.7% among patients transferred from the intensive care unit to the ward (n = 18), and 33% among patients transferred from the ward to the intensive care unit (n = 3). Pulmonary aspiration is an uncommon and generally benign event among enterally supported patients. More frequent aspiration among ward than intensive care unit patients suggests that aspiration is not an inevitable consequence of severe illness, but can be prevented with adequate nursing care and pulmonary precautions. The fear of aspiration is not a sufficient cause to withhold enteral nutrition support in acutely ill patients.