Pepsin A in Tracheal Secretions From Patients Receiving Mechanical Ventilation.
Steven Talbert, Annette M Bourgault, Kimberly Paige Rathbun and 4 others
PMID 34719715WHAT IT FOUND
After accounting for illness severity, pepsin A in tracheal secretions did not show a clear association with ventilator-associated conditions or death.
Pepsin-positive patients had longer ventilation and ICU stay, but this observational study cannot prove microaspiration caused them.
Key findings
01In the 297 patients with tracheal specimens analyzed, 130 had at least one pepsin A positive tracheal specimen, and median time to first positive specimen was day 2.
02After controlling for APACHE II scores, pepsin A positive tracheal specimens were not significantly associated with VACs or mortality.
03Pepsin A positive patients had longer mechanical ventilation (156 hours vs 103 hours) and longer ICU stay (9.8 days vs 8.3 days) after controlling for APACHE II scores.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Only 297 of the 513 enrolled patients were included because they consented to additional testing of stored specimens. The study measured pepsin A every 12 hours, so brief microaspiration events may have been missed. There is no gold standard for pepsin A measurement, and the assay used a 6.25 ng/mL cutoff. Most patients received a form of enteral nutrition, which was not accounted for in the analysis. Sample size disparities may have contributed to lack of significant differences in some outcomes. The number of IVAC and possible VAP cases was low, so those results are unstable. The study did not test a treatment effect, so it cannot show that microaspiration caused outcomes.
Declared interests
The supplied text lists the article as research support from the N.I.H., Extramural. It does not provide an author conflict of interest statement or funding declaration beyond that.
The easy way to misread this
Do not read the longer ventilation and ICU stay as proof that microaspiration caused those outcomes. The study was observational, the adjusted primary association with VACs was null, and it did not test a treatment.