Intubation Setting, Aspiration, and Ventilator-Associated Conditions
- 1 September 2020
- journal article
- research article
- Published by AACN Publishing in American Journal of Critical Care
- Vol. 29 (5), 371-378
- https://doi.org/10.4037/ajcc2020129
Abstract
Patients experience endotracheal intubation in various settings with wide-ranging risks for postintubation complications such as aspiration and ventilator-associated conditions. To evaluate associations between intubation setting, presence of aspiration biomarkers, and clinical outcomes. This study is a subanalysis of data from the NO-ASPIRATE single-blinded randomized clinical trial. Data were prospectively collected for 513 adult patients intubated within 24 hours of enrollment. Patients with documented aspiration events at intubation were excluded. In the NO-ASPIRATE trial, intervention patients received enhanced oropharyngeal suctioning every 4 hours and control patients received sham suctioning. Tracheal specimens for α-amylase and pepsin tests were collected upon enrollment. Primary outcomes were ventilator hours, lengths of stay, and rates of ventilator-associated conditions. Of the baseline tracheal specimens, 76.4% were positive for α-amylase and 33.1% were positive for pepsin. Proportions of positive tracheal α-amylase and pepsin tests did not differ significantly between intubation locations (study hospital, transfer from other hospital, or field intubation). No differences were found for ventilator hours or lengths of stay. Patients intubated at another hospital and transferred had significantly higher ventilator-associated condition rates than did those intubated at the study hospital (P = .02). Ventilator-associated condition rates did not differ significantly between patients intubated in the field and patients in other groups. Higher ventilator-associated condition rates associated with interhospital transfer may be related to movement from bed, vehicle loading and unloading, and transport vehicle vibrations. Airway assessment and care may also be suboptimal in the transport environment.Keywords
This publication has 34 references indexed in Scilit:
- Accuracy of Alpha Amylase in Diagnosing Microaspiration in Intubated Critically-Ill PatientsPLOS ONE, 2014
- Airway Pepsin Levels in Otherwise Healthy Surgical Patients Receiving General Anesthesia With Endotracheal IntubationSocial psychiatry. Sozialpsychiatrie. Psychiatrie sociale, 2013
- Difficult prehospital endotracheal intubation – predisposing factors in a physician based EMSResuscitation, 2011
- Ventilator-associated pneumonia management in critical illnessCurrent Opinion in Gastroenterology, 2011
- Cytotoxicity and Induction of Inflammation by Pepsin in Acid in Bronchial Epithelial CellsInternational Journal of Inflammation, 2011
- Hypothesis testing, type I and type II errorsIndustrial Psychiatry Journal, 2009
- Research electronic data capture (REDCap)—A metadata-driven methodology and workflow process for providing translational research informatics supportJournal of Biomedical Informatics, 2008
- Pepsin in bronchoalveolar lavage fluid: a specific and sensitive method of diagnosing gastro-oesophageal reflux–related pulmonary aspirationJournal of Pediatric Surgery, 2006
- Detection of pepsin in tracheal secretions after forced small‐volume aspirations of gastric juiceJournal of Parenteral and Enteral Nutrition, 2004
- Detection of pulmonary aspiration of gastric contents in an animal model by assay of peptic activity in bronchoalveolar fluidCritical Care Medicine, 1996