Document Detail


Pulmonary aspiration of gastric contents in patients receiving mechanical ventilation: the effect of body position.
MedLine Citation:
PMID:  1543307     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To determine if the semirecumbent position (45-degree angle) decreases aspiration of gastric contents to the airways in intubated and mechanically ventilated patients. DESIGN: A randomized, two-period crossover trial. SETTING: Respiratory intensive care unit. PATIENTS: Nineteen patients requiring intubation and mechanical ventilation. INTERVENTIONS: Patients were studied in the supine and semirecumbent positions on two separate days. MEASUREMENTS: After technetium (Tc)-99m sulphur colloid labeling of gastric contents, sequential radioactive counts in endobronchial secretions were measured at 30-minute intervals over a 5-hour period. Samples of endobronchial secretions, gastric juice, and pharyngeal contents were obtained for qualitative bacterial cultures. RESULTS: Mean radioactive counts in endobronchial secretions were higher in samples obtained while patients were in the supine position than in those obtained while patients were in the semirecumbent position (4154 cpm compared with 954 cpm; P = 0.036). Moreover, the aspiration pattern was time-dependent for each position: For the supine position, radioactivity was 298 cpm at 30 min and 2592 cpm at 300 min (P = 0.013); for the semirecumbent position, radioactivity was 103 cpm at 30 min and 216 cpm at 300 min (P = 0.04). The same microorganisms were isolated from stomach, pharynx, and endobronchial samples in 32% of studies done while patients were semirecumbent and in 68% of studies done while patients were in the supine position. CONCLUSIONS: We conclude that the supine position and length of time the patient is kept in this position are potential risk factors for aspiration of gastric contents. Elevating the head of the bed for patients who can tolerate the semirecumbent position may be a simple, no-cost prophylactic measure.
Authors:
A Torres; J Serra-Batlles; E Ros; C Piera; J Puig de la Bellacasa; A Cobos; F Lomeña; R Rodríguez-Roisin
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Publication Detail:
Type:  Clinical Trial; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Annals of internal medicine     Volume:  116     ISSN:  0003-4819     ISO Abbreviation:  Ann. Intern. Med.     Publication Date:  1992 Apr 
Date Detail:
Created Date:  1992-04-08     Completed Date:  1992-04-08     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0372351     Medline TA:  Ann Intern Med     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  540-3     Citation Subset:  AIM; IM    
Affiliation:
Universitat de Barcelona, Spain.
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MeSH Terms
Descriptor/Qualifier:
Female
Gastric Juice / microbiology
Humans
Male
Middle Aged
Pharynx / microbiology
Pneumonia, Aspiration / etiology*,  prevention & control*
Posture
Respiration, Artificial / adverse effects*,  methods*
Risk Factors
Supine Position
Technetium Tc 99m Sulfur Colloid / diagnostic use
Trachea / microbiology
Chemical
Reg. No./Substance:
0/Technetium Tc 99m Sulfur Colloid

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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