The incidence and immediate respiratory consequences of pulmonary aspiration of enteral feed

Pj Young,U Roy,J Watson

doi:10.1186/cc1677

Abstract

The cause of a respiratory deterioration in a critically ill patient frequently remains unknown. Pulmonary aspiration of enteral feed during tracheal intubation may be recognised at the bedside by the appearance of feed in the tracheal aspirate but is commonly unrecognised. To reduce aspiration it is important to be able to detect it at the bedside and hence alter management to reduce risk factors. Techniques to detect feed aspiration using food colouring have poor sensitivity and are linked with mortality in septic patients [1]. The standard glucose oxidase strip method for detecting aspiration is also insensitive because the glucose levels in feeds are similar to those of normal tracheal aspirates. We have previously described a modified glucose oxidase test strip method with an improved sensitivity [2] whereby the glucose concentration of the feed is markedly increased.

Highlights

Intra-abdominal pressure (IAP) is an important parameter and prognostic indicator of the patient’s underlying physiologic status [1]
Smaller aerosol particles resulted in greater drug delivery in vitro when using the modified Aeroneb Pro during controlled mechanical ventilation (CMV)
We retrospectively reviewed 107 procedures performed on 48 patients in the period between March 2000 and November 2001

Summary

Introduction

Intra-abdominal pressure (IAP) is an important parameter and prognostic indicator of the patient’s underlying physiologic status [1]. The aim of this study was to assess the respiratory effects of sufentanil and remifentanil in postsurgical critically ill patients during spontaneous ventilation since the drugs show pharmacokinetic and pharmacodynamic properties which make them attractive for intensive care use. Preliminary evidence suggests that hU-II levels during cardiac surgery are increased in patients with myocardial dysfunction [2] It is not known, if hU-II plasma concentrations are related to pulmonary capillary wedge pressure (PCWP) as an estimate of left ventricular filling pressure. AAF in cardiac surgery postoperative period has been implicated as a complication that leads to longer ICU and hospital stay and to augmented costs It has not been associated with increased mortality rates. We aimed to investigate the effects of use of preoperative and early postoperative standard and immunonutrient products on immune system and acute inflammatory response in the patients undergoing gastrointestinal malignancy surgery.

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