Risk factors of aspiration of gastrointestinal contents in patients with mechanical ventilation in neurosurgical ICU

Abstract

Objective To explore the high-risk factors of tracheobronchial aspiration of gastric contents of patients in Neurosurgical ICU, so as to provide basis for aspiration prevention as well as related complications. Methods The prospective cohort study was conducted during the patients with mechanical ventilation who were continuously enrolled. The general information and condition of 74 patients from two tertiary hospitals were recorded and their tracheal secretions were collected. The content of pepsin A in airway secretions was determined whether there is an aspiration. Results The incidence rate of aspiration in 74 patients was 39.2%. The chi-square test results showed that the angle of backrest elevation, the rate of enteral nutrition pump, diameter of nasogastric feeding tube, gastric residual volume, airbag pressure, Glasgow score and the use of sedatives were all related to the occurrence of aspiration (χ2/F =30.771, 16.845, 11.471, 9.212, 6.582, 15.664, 11.722, 18.312; P<0.05) . Logistic regression analysis indicated five risk factors related to aspiration, including bed elevation angle, rate of enteral nutrition pump speed, airbag pressure, whether the use of sedatives and gastric residual volume. AUC of risk score calculation is 0.994, RR=1.979 (1.351, 2.900) . The risk of patients whose AUC score≥10 was double of patients whose AUC score<10. Conclusions To reduce the incidence of aspiration of gastric contents, for patients without contraindications, angle of backrest greater than 30 degrees, maintaining cuff pressure between 20 and 30 cmH2O, nasogastric feeding rate<25 ml/hour, small bowel feeding rate<45 ml/hour, and GRVs ≥50 ml, gastric feedings and enteral nutrition are recommended; pay attention to patients usingsedative drugs, can also reduce the aspiration rate of gastric contents. Key words: Gastrointestinal contents; Risk factors; Neurosurgery; Intensive care unit; Aspiration