Association of enteral feeding with microaspiration in critically ill adults.
Annette M Bourgault, Rui Xie, Steven Talbert and 1 others
PMID 36116866WHAT IT FOUND
Gastric microaspiration occurred in 39% of mechanically ventilated ICU patients.
Enteral feeding was associated with gastric microaspiration, but distal tubes did not prevent it, and patients not receiving feeding who aspirated were mostly frequent aspirators.
Key findings
01Positive tracheal pepsin A occurred in 111/283 (39%) mechanically ventilated patients at least once.
02Enteral feeding was associated with positive tracheal pepsin A (chi-square = 6.22, p = 0.01), and 87/195 patients who received enteral feeding most of the time aspirated.
03Distal feeding tube location was associated with aspiration at the patient level (chi-square = 5.88, p = 0.03), and positive pepsin A was measured in 55.6% of events with post-pyloric tubes versus 48.6% of events with gastric tubes.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This was a secondary analysis of a parent study powered for pulmonary outcomes, not enteral nutrition, and the authors state it was underpowered for enteral feeding variables. Pepsin A was added partway through the parent study as a proxy measure, so only a subset of patients had these data. The analysis did not measure or include variables that could explain microaspiration, such as gastroesophageal reflux, enteral feeding intolerance, vomiting, coughing, lower esophageal sphincter integrity, gastric distension, or oropharyngeal dysphagia. Tracheal samples were taken every 12 hours, and pepsin A can clear quickly, so many microaspiration events may have been missed. Event-level results use 2408 samples from 283 patients and may overstate certainty compared with patient-level results. Head of bed elevation and endotracheal tube cuff pressure were checked only at set times, so undocumented variation between checks is possible. Feeding tube location, formula rate, and sedation changed over time, and the patient-level classification used the value held for most time points. Gastric residual volume data were missing for about one third of the subset, and only two patients had high values, so that analysis was too small to be meaningful. The study reports associations, not tested effects of enteral feeding or tube location, and it cannot show that any component caused aspiration.
The easy way to misread this
Do not withhold enteral feeding to prevent microaspiration based on this paper. It reports an association in a secondary analysis, not a tested effect, and patients not receiving feeding still aspirated; 13/15 (87%) of those aspirators were frequent aspirators.