The aspiration of oral and gastric substances is a well-known risk for ventilator associated pneumonia (VAP) in the intubated, mechanically ventilated (MV), patient of the intensive care unit (ICU) population. The gastric biomarker pepsin and the oral biomarker salivary amylase have been identified as evidence of aspiration prior to the manifestation of acute pulmonary illness. In an effort to decrease the risk for aspiration, several evidence based nursing practices are in place. Actions include 30 degree head of the bed positioning, oral care, suctioning, and circuit change interval protocols, as well as the administration of medication with the objective of reducing acid reflux. Additional recommendations concern the type of endotracheal tube (ETT) used to ventilate the intubated patient. The continuous subglottic suctioning endotracheal tube (CSS-ETT) features an additional port which continually suctions secretions that accumulate above the inflated endotracheal cuff. Patients with standard endotracheal tubes (S-ETT) receive manual, as needed suctioning of accumulated secretions in the mouth and the oropharynx per agency protocol. Research of the critical care population has demonstrated a decreased instance of VAP using CSS-ETT as compared to S-ETT utilization. This study sought to compare the incidence of the biomarkers pepsin and salivary amylase in the suctioned oral and tracheal secretions of patients with S-ETT compared to patients with CSS-ETT. Part of the protocol of a descriptive, comparative study of the clinical indicators for suctioning established the collection of the paired suctioned oral and tracheal aspirates. Those collected aspirates were analyzed for a pilot study of pepsin and amylase analysis. This study compares the incidence of aspirates in oral and tracheal secretions by endotracheal tube type.; The intention of this study was that it would assist in demonstrating beneficial aspects of the selection of the CSS-ETT. It is considered that further investigation with a larger population group could add statistical significance.; Tracheal aspirates were obtained with a closed tracheal suction device while oral secretions were obtained with a suction catheter designed to reach the oropharynx. Biomarkers assayed were the gastric marker pepsin and the oropharyngeal marker salivary amylase. Assays of pepsin and salivary amylase were performed using standard procedures in a specialty diagnostic laboratory. Specimens were obtained from 11 subjects: 8 male and 3 female. The majority were Caucasian (n=9), had a CSS-ETT (n=8), were on mechanical ventilation in the synchronized intermittent mandatory ventilation mode, and on tube feedings (n=9) located in the stomach (n=7). The mean age was 56 years. Feeding tubes were placed in 9 patients, and the majority of the tubes were Dobbhoff. Pepsin was found in the oral secretions of 62.5% (n = 5) of the CSS-ETT subjects, while 50.0% (n = 4) had pepsin in the tracheal aspirate. Pepsin was found in the oral secretions of 66.7% (n = 2) of the S-ETT subjects, and 66.7% (n = 2) had pepsin in their tracheal aspirate. All subjects of both groups (n = 11) had oral salivary amylase detected. Salivary amylase was detected in the tracheal aspirate of 100% (n = 3) of the S-ETT subjects versus 62.5% (n = 5) in CSS-ETT group. Based on the results of this study, there was a reduction in the number of subjects who had oral compared to tracheal aspirate pepsin in the CSS-ETT group (n = 5 oral versus n = 4 tracheal) tube type. The S-ETT group had equal number of subjects with oral (n = 2) and tracheal pepsin detected (n = 2). However, the results when comparing the S-ETT and the CSS-ETT groups were not statistically significant (p = 0.898 pepsin oral and 0.621 tracheal pepsin). There may be clinical significance. It appears that the CSS-ETT was beneficial in that group; two fewer subjects had pepsin in their tracheal aspirate (n = 5 oral versus n = 4 tracheal aspirate pepsin).
| Identifer | oai:union.ndltd.org:ucf.edu/oai:stars.library.ucf.edu:honorstheses1990-2015-2340 |
| Date | 01 December 2012 |
| Creators | Allen, Katherine |
| Publisher | STARS |
| Source Sets | University of Central Florida |
| Language | English |
| Detected Language | English |
| Type | text |
| Format | application/pdf |
| Source | HIM 1990-2015 |
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