I is there a way to detect aspiration early and routinely other than obtaining tracheal aspirate cultures? Pepsin detects gastric secretions in tracheal aspirate but breaks down quickly after aspiration. Amylase is present and may also detect oral secretions in tracheal aspirate. Sole and colleagues investigated the use of both pepsin and amylase to detect microaspiration and found the following:

  • Pepsin, amylase, or both were detected in tracheal secretions of 9 out of 13 intubated patients (69%).

    • ○ Four out of 14 patients (31%) had pepsin only

    • ○ Two out of 14 patients (15%) had amylase only

    • ○ Three out of 14 patients (23%) had both pepsin and amylase

  • All 9 patients had head-of-bed elevations 30° or higher and endotracheal cuff pressures of 20 cm H2O or more. In addition, six of the 9 patients had subglottic endotracheal tubes.

Amylase may...

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