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Association of enteral feeding with microaspiration in critically ill adults
Annette M Bourgault1, Rui Xie2, Steven Talbert1
1University of Central Florida, College of Nursing, USA.
Aim:
This study explored relationships between enteral feeding and tracheal pepsin A.
Background:
Mechanically ventilated (MV) patients receiving enteral feeding are at risk for microaspiration. Tracheal pepsin A, an enzyme specific to gastric cells, was a proxy for microaspiration of gastric secretions.
Methods:
Secondary analysis of RCT data from critically ill, MV adults was conducted. Microaspiration prevention included elevated head of bed, endotracheal tube cuff pressure management, and regular oral care. Tracheal secretions for pepsin A were collected every 12 h. Microaspiration was defined as pepsin A ≥ 6.25 ng/mL. Positive pepsin A in >30 % of individual tracheal samples was defined as abundant microaspiration (frequent aspirator). Chi-squared, Fisher's Exact test, and generalized linear model (GLM) were used.
Results:
Tracheal pepsin A was present in 111/283 (39 %) mechanically ventilated patients and 48 (17 %) had abundant microaspiration. Enteral feeding was associated with tracheal pepsin A, which occurred within 24 h of enteral feeding. Of the patients who aspirated, the majority received some enteral feeding 96/111 (86 %), compared to only 15/111 (14 %) who received no feeding. A greater number of positive pepsin A events occurred with post-pyloric feeding tube location (55.6 %) vs. gastric (48.6 %), although significant only at the event-level. Frequent aspirators (abundant pepsin A) had higher pepsin A levels compared to infrequent aspirators.
Conclusions:
Our findings confirmed the stomach as the microaspiration source. Contrary to other studies, distal feeding tube location did not mitigate microaspiration. Timing for first positive pepsin A should be studied for possible association with enteral feeding intolerance.
Insights
Enteral feeding in mechanically ventilated patients is linked to tracheal pepsin A, indicating gastric microaspiration. Distal feeding tube placement did not prevent this aspiration, suggesting further study is needed.
Area of Science:
- Critical Care Medicine
- Gastroenterology
- Respiratory Medicine
Background:
- Mechanically ventilated (MV) patients on enteral feeding face risks of microaspiration.
- Tracheal pepsin A, a gastric-specific enzyme, serves as a biomarker for microaspiration of gastric contents.
Purpose of the Study:
- To investigate the association between enteral feeding and the presence of tracheal pepsin A in critically ill, MV adults.
- To determine if feeding tube location influences microaspiration events.
Main Methods:
- Secondary analysis of randomized controlled trial data.
- Tracheal secretions collected every 12 hours to measure pepsin A levels.
- Microaspiration defined as pepsin A ≥ 6.25 ng/mL; abundant microaspiration as >30% positive samples.
Main Results:
- Tracheal pepsin A detected in 39% of MV patients; 17% had abundant microaspiration.
- Enteral feeding was significantly associated with tracheal pepsin A, often within 24 hours.
- Post-pyloric feeding tubes showed a trend towards more positive pepsin A events than gastric tubes.
Conclusions:
- Confirms the stomach as the source of microaspiration in this population.
- Distal feeding tube location did not significantly reduce microaspiration.
- Further research on the timing of pepsin A detection may link to enteral feeding intolerance.
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