• Steven Talbert, Christine Wargo Detrick, Kimberly Emery, Aurea Middleton, Bassam Abomoelak, Chirajyoti Deb, Devendra I Mehta, and Mary Lou Sole.
• Steven Talbert is an assistant clinical professor, Christine Wargo Detrick is a doctoral student, and Kimberly Emery is a doctoral candidate, University of Central Florida College of Nursing, Orlando, Florida.
• Am. J. Crit. Care. 2020 Sep 1; 29 (5): 371-378.

BackgroundPatients experience endotracheal intubation in various settings with wide-ranging risks for postintubation complications such as aspiration and ventilator-associated conditions.ObjectivesTo evaluate associations between intubation setting, presence of aspiration biomarkers, and clinical outcomes.MethodsThis study is a subanalysis of data from the NO-ASPIRATE single-blinded randomized clinical trial. Data were prospectively collected for 513 adult patients intubated within 24 hours of enrollment. Patients with documented aspiration events at intubation were excluded. In the NO-ASPIRATE trial, intervention patients received enhanced oropharyngeal suctioning every 4 hours and control patients received sham suctioning. Tracheal specimens for α-amylase and pepsin tests were collected upon enrollment. Primary outcomes were ventilator hours, lengths of stay, and rates of ventilator-associated conditions.ResultsOf the baseline tracheal specimens, 76.4% were positive for α-amylase and 33.1% were positive for pepsin. Proportions of positive tracheal α-amylase and pepsin tests did not differ significantly between intubation locations (study hospital, transfer from other hospital, or field intubation). No differences were found for ventilator hours or lengths of stay. Patients intubated at another hospital and transferred had significantly higher ventilator-associated condition rates than did those intubated at the study hospital (P = .02). Ventilator-associated condition rates did not differ significantly between patients intubated in the field and patients in other groups.ConclusionsHigher ventilator-associated condition rates associated with interhospital transfer may be related to movement from bed, vehicle loading and unloading, and transport vehicle vibrations. Airway assessment and care may also be suboptimal in the transport environment.©2020 American Association of Critical-Care Nurses.

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