Determining Aspiration of Oral Secretions and the Potential Impact on Evaluation of Dysphagia and VAP in Patients With Tracheostomies Using an Automated Intermittent Subglottic Aspiration System

Abstract

SESSION TITLE: Respiratory Care SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PM PURPOSE: The Modified Evans Blue Dye Test (MEBDT) has been formally used since 1995 to evaluate aspiration in patients with tracheostomies who frequently have dysphagia or other swallowing problems. In the test, clinicians deflate the cuff of the tracheal tube. Blue dye (typically FD&C Blue No. 1) is added to food (e.g. applesauce) and then fed to the patient. Following suctioning of the lower regions of the tracheal tube, past the deflated cuff, if any dye is seen in the suctioned fluids, the patient is diagnosed with a swallowing disorder, since the contaminated contents were drawn from the lower airways, where they can cause ventilator-associated pneumonia (VAP) and ventilator-associated events (VAE). The reliability, sensitivity, and specificity of the MEBDT have long been questioned. The test relies on important factors such as duration of suctioning and operator technique. False negative results have been shown to occur in over 50% of tests performed, putting patients at risk. METHODS: The automated intermittent subglottic aspiration system is FDA cleared and specifically approved for the removal of subglottic secretion drainage from above the ballooned cuff of tracheal tubes with an integrated suction port. The system facilitates the intermittent suctioning of oropharynx and gastric secretions before they can travel beyond the cuff and into the lungs. In this separate and novel application, the clinician places a few drops of green dye on the back of the tongue of the patient, then suctions secretions from above the ballooned cuff using the aspiration system. If green dye is collected in the disposal canister of the system, the presence of aspirated oral secretions is identified. RESULTS: The new technique offers multiple potential improvements over the traditional MEBDT. The new method does not require that a patient ingest foods, and does not require that dye travel beyond a deflated cuff to be collected in the lower airways by tracheal suction. In a trial study of 10 patients who were tracheostomized on mechanical ventilation and passed the MEBDT, aspiration of oral secretions was identified with this new assessment. These findings can predict the increased risk of saliva and oral secretion aspiration and potential VAE. In addition, it raises the question of clinical significance of the relationship between aspiration of oral secretions and potential aspiration of food. CONCLUSIONS: The new technique which uses small amounts of green dye on the tongue in combination with the automated intermittent aspiration system offers a potentially safe, highly accurate, and well tolerated way to diagnose aspiration of oral secretions and the increased risk of potential aspiration of food. CLINICAL IMPLICATIONS: This new test eliminates the variables that make the Evan's Modified Blue Dye test unreliable and ineffective at the diagnosis of dysphagia. This new test also eliminates the need for the patient to actually aspirate the apple sauce and dye in order to make a positive diagnosis of dysphagia. The new technique also can record the actual volume of secretion microaspiration that can lead to VAE in mechanically ventilated patients. This test is non-invasive and tolerated well by the patients. DISCLOSURE: The following authors have nothing to disclose: Gerald Gentile No Product/Research Disclosure Information