Abstract
ObjectivesAmylase concentration in respiratory secretions was reported to be a potentially useful marker for aspiration and pneumonia. The aim of this study was to determine accuracy of α-amylase in diagnosing microaspiration in critically ill patients.MethodsRetrospective analysis of prospectively collected data collected in a medical ICU. All patients requiring mechanical ventilation for at least 48 h, and included in a previous randomized controlled trial were eligible for this study, provided that at least one tracheal aspirate was available for α-amylase measurement. As part of the initial trial, pepsin was quantitatively measured in all tracheal aspirates during a 48-h period. All tracheal aspirates were frozen, allowing subsequent measurement of α-amylase for the purpose of the current study. Microaspiration was defined as the presence of at least one positive tracheal aspirate for pepsin (>200 ng.mL−1). Abundant microaspiration was defined as the presence of pepsin at significant level in >74% of tracheal aspirates.ResultsAmylase was measured in 1055 tracheal aspirates, collected from 109 patients. Using mean α-amylase level per patient, accuracy of α-amylase in diagnosing microaspiration was moderate (area under the receiver operator curve 0.72±0.05 [95%CI 0.61–0.83], for an α-amylase value of 1685 UI.L−1). However, when α-amylase levels, coming from all samples, were taken into account, area under the receiver operator curve was 0.56±0.05 [0.53–0.60]. Mean α-amylase level, and percentage of tracheal aspirates positive for α-amylase were significantly higher in patients with microaspiration, and in patients with abundant microaspiration compared with those with no microaspiration; and similar in patients with microaspiration compared with those with abundant microaspiration. α-amylase and pepsin were significantly correlated (r2 = 0.305, p = 0.001).ConclusionAccuracy of mean α-amylase in diagnosing microaspiration is moderate. Further, when all α-amylase levels were taken into account, α-amylase was inaccurate in diagnosing microaspiration, compared with pepsin.
Highlights
Despite the increased use of non-invasive ventilation, and highflow nasal oxygen in patients with acute respiratory failure, intubation is still frequently performed in critically ill patients [1]
This procedure is associated with several complications, including ventilator-associated pneumonia (VAP), and tracheal ischemic lesions [2]
These tracheal aspirates were collected from 109 patients, representing 89% of the 122 patients included in the first trial
Summary
Despite the increased use of non-invasive ventilation, and highflow nasal oxygen in patients with acute respiratory failure, intubation is still frequently performed in critically ill patients [1]. This procedure is associated with several complications, including ventilator-associated pneumonia (VAP), and tracheal ischemic lesions [2]. Diagnosis of microaspiration in intubated critically-ill patients is important, in order to evaluate the efficiency of preventive measures aiming at decreasing the incidence of microaspiration, and VAP [10,11]. To test the efficiency of a new device aiming at preventing microaspiration, and VAP, it would be easier to first perform preliminary studies to evaluate the efficiency of such a device in preventing microaspiration before conduction large multicenter studies to test its impact on VAP incidence
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