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Published on: January 17, 2011
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.
Insights
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.
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.
Abstract:
Aspiration is common in mechanically ventilated patients and may predispose patients to aspiration pneumonia, chemical pneumonitis, and chronic lung damage. Pepsin A is a specific marker of gastric fluid aspiration and is often detected in ventilated pediatric patients. We investigated the effect of oral care and throat suctioning in the detection of pepsin A in tracheal aspirates (TAs) up to 4 hours after these procedures.
Methods:
Twelve pediatric patients between age 2 weeks to 14 years who underwent intubation for cardiac surgery were enrolled in this study. Six of the 12 patients were consented before their surgery with initial specimen collected at the time of intubation and last one shortly before extubation (intubation duration < 24 hours). The remaining 6 patients were consented after cardiac surgery. All specimens were collected per routine care per respiratory therapy protocol and shortly before extubation (intubation duration > 24 hours). Tracheal fluid aspirates were collected every 4 to 12 hours in the ventilated patients. Enzymatic assay for gastric pepsin A and protein determination were performed. The time of oral care and throat suctioning within 4 hours prior was recorded prospectively.
Results:
A total of 342 TA specimens were obtained from the 12 intubated pediatric patients during their course of hospitalization; 287 (83.9%) showed detectable total pepsin (pepsin A and C) enzyme activity (> 6 ng/mL) and 176 (51.5%) samples had detectable pepsin A enzyme levels (>6 ng/mL of pepsin A). Only 29 samples of 76 samples (38.2%) had evidence of microaspiration after receiving oral care, while 147 of 266 (55.3%) samples were pepsin A positive when no oral care was provided. Odds ratio is 0.50 (Cl 0.30-0.84), and the number needed to treat is 5.8 (Confidence interval 3.4-22.3). Testing air filters for pepsin was not beneficial.
Conclusion:
Oral care is a highly effective measure to prevent microaspiration of gastric fluid in ventilated pediatric patients. The number needed to treat (5.8) suggests this is a very effective prevention strategy. Our study suggests that pepsin A is a useful and sensitive biomarker that allows identification of gastric aspiration.
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