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. In one study,1 patients identified as frequent aspirators had a 4 times greater risk of developing pneumonia. Aspiration pneumonia accounts for 5% to 15% of pneumonias in the hospitalized population.2 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.
Use sedatives as sparingly as feasible.
For tube-fed patients, assess feeding tube placement at 4-hour intervals to ensure that the tube...