Assessment of the prevalence of microaspiration by gastric pepsin in the airway of ventilated children
Assessment of the prevalence of microaspiration by gastric pepsin in the airway of ventilated children
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DOI：
10.1111/j.1651-2227.2007.00578.x
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发表时间：
2008-01-01
期刊：
影响因子：
3.8
通讯作者：
Mehta, Devendra I.
中科院分区：
文献类型：
--
作者：
Gopalareddy, Vani;He, Zhaoping;Mehta, Devendra I.
目的：机械通气患者有误吸胃内容物的风险。这项观察性研究的目的是确定使用带套囊和不带套囊的气管内 (ET) 插管和气管切开术的儿童中微误吸的发生率，并评估喂养状态对误吸的影响。通过测量气管抽吸物中的胃蛋白酶来确定微误吸。方法：我们研究了儿科重症监护病房 (PICU) 中使用呼吸机的 27 名儿童和因各种适应症接受择期手术的 10 名儿童。气管抽吸物收集自重症监护病房在医学指示抽吸期间接受通气支持的儿童以及手术室中接受择期手术的儿童组。通过酶法检测胃蛋白酶。结果：PICU 中总体 70% 的病例至少在一次抽吸物中胃蛋白酶呈阳性。带套囊组的胃蛋白酶阳性率显着低于不带套囊组和气管切开组。管饲并没有显着影响胃蛋白酶阳性率。结论：气管支气管液中胃蛋白酶的测量是检测机械通气儿童误吸并评估 PICU 环境中预防措施有效性的敏感工具。
Aim: Mechanically ventilated patients are at risk for aspiration of gastric contents. The aim of this observational study was to determine the prevalence of micro-aspiration in children with cuffed and uncuffed endotracheal (ET) tubes and with tracheostomies and to assess the effect of feeding status on aspiration. Micro-aspiration was determined by measuring gastric pepsin in tracheal aspirates.Methods: We studied 27 children on ventilators in paediatric intensive care unit (PICU) and 10 children undergoing elective surgeries for various indications. Tracheal aspirates were collected from children on ventilatory support in the intensive care unit during medically indicated suctioning and from the group of children undergoing elective surgery in the operation room. Pepsin was detected by enzymatic assay.Results: Overall 70% of cases in PICU were positive for pepsin in at least one of the aspirates. Pepsin positivity was significantly lower in the cuffed group than in the uncuffed and tracheostomy groups. Tube feedings did not significantly influence the prevalence of pepsin positivity.Conclusions: Measurement of gastric pepsin in tracheobronchial fluid is a sensitive tool to detect aspirations in mechanically ventilated children and to assess the efficacy of preventive measures in PICU settings.