Critically ill patients have an increased risk for aspirating oropharyngeal secretions and regurgitated gastric contents. For those who are tube-fed, aspiration of gastric contents is of greater concern. While witnessed large-volume aspirations occur occasionally, small-volume clinically silent aspirations are far more common. For example, a laboratory study identified frequent microaspirations in approximately half of a large population of critically ill, mechanically ventilated patients who were receiving tube feedings. In the same study, risk for pneumonia was about 4 times greater in patients identified as frequent aspirators. Because no bedside tests are currently available to detect microaspirations, efforts to prevent or minimize aspiration take on added importance.

  • ☑ Maintain head-of-bed elevation at an angle of 30° to 45°, unless contraindicated. [Level B]

  • ☑ Use sedatives as sparingly as feasible. [Level C]

  • ☑ For tube-fed patients, assess placement of the feeding tube at 4-hour...

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