• Steven Talbert, Annette M Bourgault, Kimberly Paige Rathbun, Bassam Abomoelak, Chirajyoti Deb, Devendra Mehta, and Mary Lou Sole.
• Steven Talbert is interim director of the nursing PhD program and a clinical assistant professor, University of Central Florida College of Nursing, Orlando, Florida.
• Am. J. Crit. Care. 2021 Nov 1; 30 (6): 443-450.

BackgroundIn patients in the intensive care unit (ICU) receiving mechanical ventilation, aspiration of gastric contents may lead to ventilator-associated events and other adverse outcomes. Pepsin in pulmonary secretions is a biomarker of microaspiration of gastric contents.ObjectivesTo evaluate the association between tracheal pepsin A and clinical outcomes related to ventilator use.MethodsA subset of 297 patients from a larger clinical trial on aspiration of oral secretions in adults receiving mechanical ventilation consented to have pepsin A measured in their tracheal aspirate samples. A concentration ≥6.25 ng/mL indicated a positive result. Abundant microaspiration was defined as pepsin A in ≥30% of samples. Statistical analyses included analysis of variance, analysis of covariance, and χ2 tests.ResultsMost patients were White men, mean age 59.7 (SD, 18.8) years. Microaspiration was found in 43.8% of patients (n = 130), with abundant microaspiration detected in 17.5% (n = 52). After acuity was controlled for, patients with tracheal pepsin A had a longer mechanical ventilation duration (155 vs 104 hours, P < .001) and ICU stay (9.9 vs 8.2 days, P = .04), but not a longer hospital stay.ConclusionsMicroaspiration of gastric contents occurred in nearly half of patients and was associated with a longer duration of mechanical ventilation and a longer stay in the ICU. Additional preventative interventions beyond backrest elevation, oropharyngeal suctioning, and management of endotracheal tube cuff pressure may be needed. Also, the timing of pepsin measurements to capture all microaspiration events requires additional exploration.©2021 American Association of Critical-Care Nurses.

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