Development of a 'Nurse-Friendly' Bedside Test for Aspiration

描述(由申请人提供)：拟议研究的最终目的是开发一种可靠的床边测试来检测肺吸入胃内容物。这样的测试对接受管内喂养的危重、机械通气患者特别重要。虽然这些人偶尔会出现明显的大容量渴望，但反胃内容物的微小渴望要常见得多。这些微小的渴望通常在临床上是沉默的，直到它们累积导致肺部问题(如化学性肺炎或潜在威胁生命的吸入性肺炎)。目前，还没有可靠的床边抽吸试验。不幸的是，如果没有这样的测试，护士们无法区分频繁和罕见的静默吸入器。这反过来又阻碍了他们及时干预以防止患者预后不良的能力。我们的研究团队已经开发出一种高度灵敏和特异的胃酶实验室分析方法，它可以作为胃内容物吸入肺的代用品。该测试已有效地用于研究环境，测试500多名机械通气患者的吸入性。虽然我们的实验室检测提供了准确和有用的结果，但它需要大约24小时才能完成。这项拟议的研究将试图在5分钟内改进我们的实验室化验方法，以便在床边使用。这项化验将基于生物化学合作者在拟议的研究中开发的新技术(称为分子钳子技术)。新的基于抗体的传感器设计允许快速和灵敏地检测目标蛋白质，比实验室检测相同蛋白质所需的步骤要少得多。共有2200份人体气管、支气管分泌物可用于该项目，当床边分析与参考实验室分析进行比较时，这些分泌物将用于确定敏感性、特异性和重复性的测量。公共卫生相关性：这项研究的目的是开发一种床边检测方法，以检测胃内容物的肺微呼气。需要这样的测试来区分频繁和不频繁的吸引器，以便可以相应地计划干预措施。共有2200份人体气管、支气管分泌物可用于该项目，当床边分析与参考实验室分析进行比较时，这些分泌物将用于确定敏感性、特异性和重复性的测量。

DESCRIPTION (provided by applicant): The ultimate aim of the proposed study is to develop a reliable bedside test to detect pulmonary aspiration of gastric contents. Such a test is of especial importance in critically ill, mechanically ventilated patients receiving tube feedings. While obvious large-volume aspirations occasionally occur in these individuals, micro-aspirations of regurgitated gastric contents are far more common. These micro-aspirations are usually clinically silent until they cumulatively lead to pulmonary problems (such as chemical pneumonitis or potentially life-threatening aspiration pneumonia). At present, there is no reliable bedside test for aspiration. Unfortunately, without such a test, nurses are unable to distinguish between frequent and infrequent silent aspirators. This, in turn, impedes their ability to intervene in a timely fashion to prevent poor patient outcomes. Our research team has developed a highly sensitive and specific laboratory assay for the major gastric enzyme, pepsin, which serves as a proxy for the aspiration of gastric contents into the lung. The test has been used effectively in a research setting to test for aspiration in over 500 mechanically ventilated patients. Although our laboratory assay provides accurate and useful results, it takes about 24 hours to perform. The proposed study will attempt to refine our laboratory assay for use at the bedside within a 5 minute period. The assay will be based on new technology (referred to as molecular pincer technology), developed by the biochemistry collaborators on the proposed study. The new antibody-based sensor design allows rapid and sensitive detection of target proteins with significantly fewer steps than required for laboratory assays of the same proteins. A total of 2,200 aliquots of human tracheobronchial secretions are available for the project and will be used to determine measures of sensitivity, specificity, and reproducibility when comparisons are made between the bedside assay and the reference laboratory assay. Public Health Relevance: The study's aim is to develop a bedside assay to detect pulmonary micro-aspirations of gastric contents. Such a test is needed to differentiate between frequent and infrequent aspirators so that interventions can be planned accordingly. A total of 2,200 aliquots of human tracheobronchial secretions are available for the project and will be used to determine measures of sensitivity, specificity, and reproducibility when comparisons are made between the bedside assay and the reference laboratory assay.