• Mary Lou Sole, Janet Conrad, Melody Bennett, Aurea Middleton, Katherine Hay, Suzanne Ash-worth, and Devendra Indulal Mehta.
• Mary Lou Sole is Orlando Health Distinguished Professor, University of Central Florida, and a research scientist at Orlando Health, Orlando, Florida. Janet Conrad is a clinical scientist in the pediatric specialty diagnostic laboratory and Devendra Indulal Mehta is the director of the pediatric gastroenterology laboratory, Arnold Palmer Hospital for Children, Orlando, Florida. Melody Bennett is a member of the adjunct faculty, University of Central Florida, and a staff nurse at Orlando Health. Aurea Middleton is a staff nurse at Orlando Health. Katherine Hay is a staff nurse at University of Alabama at Birmingham, Birmingham, Alabama. Suzanne Ashworth is a clinical nurse specialist in neurological critical care, Orlando Regional Medical Center, Orlando, Florida. mary.sole@ucf.edu.
• Am. J. Crit. Care. 2014 Jul 1;23(4):334-8.

BackgroundEndotracheal intubation increases the risk for microaspiration of secretions around the tube cuff. Pepsin has been used as a biomarker for gastric aspiration. Amylase is a newer proposed biomarker for aspiration of oral contents.ObjectiveTo assess the presence of pepsin and amylase in paired oral-tracheal secretions of adult patients treated with mechanical ventilation.MethodsIn this descriptive study, paired samples of oral and tracheal secretions were obtained from adult patients at baseline and again within 4 hours when a need for endotracheal suctioning was assessed. Assays of pepsin and amylase were processed in a specialty diagnostic laboratory.ResultsThe sample consisted of 10 men and 3 women with a median age of 56 years. The majority were intubated with a subglottic suction endotracheal tube (9 patients, 69%), receiving synchronized intermittent mandatory ventilation (10 patients; 77%), and receiving enteral feedings (11 patients; 85%) through a tube distally placed in the stomach (8 patients; 67%). Pepsin was present in oral secretions of 9 patients (69%), and in tracheal specimens of 7 patients (54%) at one or both sampling times. Amylase was detected in all patients' oral secretions and in tracheal secretions of 5 patients (38%) at one or both sampling times.ConclusionsMany patients had pepsin, amylase, or both in tracheal aspirates. Pepsin was more commonly detected than was amylase. Although the relationship of this finding to long-term outcomes was not assessed, findings indicate that microaspiration of oral and gastric secretions occurs frequently.©2014 American Association of Critical-Care Nurses.

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