Prevention of Aspiration in Adults

Critically ill patients are at increased risk of aspirating oropharyngeal secretions and regurgitated gastric contents. For those who are tube-fed, aspiration of gastric contents is of greater concern. Diagnosis of aspiration is difficult without the use of costly procedures; thus, the incidence of this condition is unclear. However, aspiration is clearly a common problem in acutely ill patients. For example, videofluoroscopically documented aspiration was reported in 42.6% of 1100 hospitalized adults (25% of the patients were aspirating silently).¹  In a laboratory study (using pepsin as a marker for aspiration of gastric contents), frequent microaspirations were identified in approximately half of 360 critically ill patients undergoing mechanical ventilation who were receiving tube feedings.²  In the same study, risk for pneumonia was about 4 times greater in patients identified as frequent aspirators. Reportedly, aspiration pneumonia represents 5% to 15% of pneumonias in the...