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Oral Care Associated With Less Microaspiration in Ventilated Cardiac Patients.

Nishant Patel1, Philip Lin1, Michael Stack2

  • 1From the Center for Digestive Health and Nutrition, Arnold Palmer Hospital for Children, Orlando, FL.

JPGN Reports
|May 14, 2023
PubMed
Summary

Oral care significantly reduces gastric fluid microaspiration in ventilated pediatric patients. Pepsin A testing in tracheal aspirates confirms its effectiveness as a biomarker for preventing aspiration pneumonia.

Keywords:
aspirationintubatedmicroaspirationoral carepepsin Apepsin Cventilated

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Area of Science:

  • Pediatric critical care medicine
  • Gastroenterology
  • Pulmonology

Background:

  • Aspiration is a frequent complication in mechanically ventilated patients, leading to pneumonia and lung damage.
  • Pepsin A serves as a specific biomarker for gastric fluid aspiration, often found in ventilated pediatric patients.
  • Investigating interventions to reduce aspiration is crucial for improving patient outcomes.

Purpose of the Study:

  • To evaluate the impact of oral care and throat suctioning on the detection of pepsin A in tracheal aspirates.
  • To determine the efficacy of oral care in preventing gastric fluid microaspiration in intubated children.

Main Methods:

  • Twelve pediatric patients undergoing intubation for cardiac surgery were included.
  • Tracheal aspirates were collected and analyzed for pepsin A enzyme activity.
  • Prospective recording of oral care and throat suctioning timing within 4 hours prior to sample collection.

Main Results:

  • Pepsin A was detected in 51.5% of tracheal aspirate samples.
  • Microaspiration (pepsin A positive) was significantly lower after oral care (38.2%) compared to no oral care (55.3%).
  • Oral care demonstrated an odds ratio of 0.50 for preventing pepsin A detection, with a number needed to treat of 5.8.

Conclusions:

  • Oral care is a highly effective strategy for preventing gastric fluid microaspiration in ventilated pediatric patients.
  • Pepsin A is a sensitive and valuable biomarker for identifying gastric aspiration in this population.
  • Implementing oral care protocols can significantly reduce the risk of aspiration-related complications.