Aspiration in intubated premature infants

Area of Science:

• Neonatal Medicine
• Pediatric Critical Care
• Respiratory Physiology

Background:

• Tracheal aspiration is a known risk in intubated children.
• Previous studies indicate a high incidence in young children.
• The effect of continuous positive airway pressure (CPAP) on aspiration in neonates is unclear.

Purpose of the Study:

• To determine the incidence of tracheal aspiration in intubated premature infants.
• To investigate the potential preventive effect of CPAP on tracheal aspiration.
• To assess physiological changes associated with aspiration in neonates.

Main Methods:

• Evaluation of 20 tracheally intubated neonates for tracheal aspiration using orally placed Evan's blue dye.
• Testing aspiration incidence at varying CPAP levels (2, 4, and 6 cm H2O).
• Monitoring transcutaneous PO2, respiratory rate, and pulse rate in aspirating versus non-aspirating infants.

Main Results:

• Overall aspiration incidence was 80% in intubated neonates.
• CPAP levels of 4 cm H2O (72% aspiration) and 6 cm H2O (50% aspiration) did not significantly reduce aspiration.
• Aspiration was associated with decreased transcutaneous PO2 and increased respiratory and pulse rates.

Conclusions:

• Tracheally intubated neonates exhibit a high frequency of tracheal aspiration.
• Clinically relevant levels of CPAP are unlikely to prevent aspiration in this population.
• Aspiration significantly impacts neonatal cardiorespiratory status.