Clinical Pearls

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:

Amylase may be a useful biomarker to detect microaspiration of oral contents but more research is needed to verify and expand these findings.

—Maureen Seckel,rn, apn, msn, aprn-bc, ccrn, ccns

See Article, pp 334–338

Early, progressive mobilization preserves neuromuscular strength, cardiovascular function, and skin integrity. It also decreases days on mechanical ventilation, and increases the likelihood of returning to independent functional status.

This case study by Brownback and colleagues demonstrates the use of evidence-based practice to make decisions about early mobilization activities in an alert patient being treated with...