CHEST Guidelines-Aspiration-Following-Elective-Intubation

Aspiration-Following-Elective-Intubation_chest

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In a recent correspondence to <em>CHEST</em>, Dr. J. Kyle Bohman discussed new findings related to gastric-to-pulmonary aspiration in adults undergoing elective intubation. The original study, published in May 2013, identified aspiration through an enzymatic assay for pepsin A, reporting a 0% aspiration rate. Since then, Bohman’s team has validated a more sensitive enzyme-linked immunosorbant assay (ELISA) for pepsin A, with a significantly lower detection threshold of 0.1 ng/mL, compared to the enzymatic assay's 25 ng/mL threshold.

Using the ELISA on the initial samples, a 4% aspiration rate was discovered. This suggests that aspiration, although low, may occur more frequently than initially reported when using conventional assays. The ELISA's higher sensitivity likely allows for detection of partially degraded pepsin A, thus offering a more accurate measurement.

Furthermore, in a separate study involving 16 adult surgical patients with microaspiration risk factors such as high BMI, diabetes, or gastroesophageal reflux disease, a 12.5% aspiration rate was observed following elective intubation. However, the sample size was too small to statistically confirm whether patients with risk factors have a significantly higher aspiration rate than those without.

Dr. Bohman, affiliated with the Mayo Clinic College of Medicine's Department of Anesthesia, Division of Critical Care Medicine, conducted this research under IRB approval. He reports no conflicts of interest. The findings highlight the sensitivity of ELISA and its potential to provide a more reliable assessment of aspiration risk in patients undergoing elective intubation. The correspondence encourages further research to confirm these observations, particularly in at-risk populations.

Keywords

gastric-to-pulmonary aspiration

elective intubation

pepsin A

enzyme-linked immunosorbant assay

ELISA

aspiration rate

microaspiration risk factors

sensitivity

Mayo Clinic

critical care medicine