Intubation Setting, Aspiration, and Ventilator-Associated Conditions.
Steven Talbert, Christine Wargo Detrick, Kimberly Emery and 5 others
PMID 32869069WHAT IT FOUND
Aspiration tests in tracheal secretions were common and did not differ by intubation location, but patients transferred from other hospitals had more ventilator-associated conditions than those intubated at the study hospital.
Key findings
01At baseline, 76.4% of patients had positive tracheal α-amylase tests and 33.1% had positive pepsin tests.
02Intubation location was not associated with baseline tracheal α-amylase or pepsin results, ventilator hours, ICU length of stay, or hospital length of stay.
03The ventilator-associated condition rate was more than double in patients transferred from other hospitals than in patients intubated at the study hospital.
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 subanalysis of a parent trial, not a randomized comparison of intubation locations, and the study hospital group was much larger than the transferred and field groups (426, 46, and 41 patients, respectively). Patients were excluded if aspiration was documented at intubation, so the sample was more aspiration-free at baseline than many field intubation studies. Baseline specimens could be collected up to 23 hours after intubation, which may affect enzyme detection. The groups differed in endotracheal tube size, urgency, reason for intubation, and primary diagnosis, so higher ventilator-associated condition rates in transferred patients may not be due to location alone. The study was single center at a level I trauma center, so results may not apply to children, nonteaching hospitals, or hospitals without trauma designation. Assays may not distinguish pepsin types, and α-amylase cutoffs vary across studies.
The easy way to misread this
Do not read the higher ventilator-associated condition rate in transferred patients as proof that transfer caused the higher rate. The baseline aspiration tests did not differ by intubation location, and the transferred group was small and differed in endotracheal tube size, urgency, reason for intubation, and diagnosis.