Chest
Volume 105, Issue 2, February 1994, Pages 563-566
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Clinical Investigations in Critical Care
Pulmonary Aspiration in Mechanically Ventilated Patients With Tracheostomies

https://doi.org/10.1378/chest.105.2.563Get rights and content

The purpose of this descriptive study was to evaluate feeding aspirations in adult patients receiving long-term mechanical ventilatory support, including the incidence of aspirations, the frequency of silent (clinically inapparent) aspirations, and differences between aspirators and nonaspirators. Aspiration data were determined by review of videofluoroscopic (VF) tapes of modified barium swallow procedures performed on 83 medically stable patients admitted to a chronic ventilator unit. Demographic and clinical variables were obtained from review of subjects’ medical records. Forty-two subjects (50 percent) aspirated during VF testing and 37 of 48 (77 percent) aspirations were silent. Subjects who aspirated were significantly older than those who did not aspirate (p = 0.007). Swallowing disorders were common, particularly disturbances of the pharyngeal phase. We conclude that feeding aspiration is seen frequently in patients with tracheostomies receiving prolonged positive pressure mechanical ventilation. Advanced age increases the risk of aspiration in this population. Episodes of aspiration are not consistently accompanied by clinical symptoms of distress to alert the bedside observer to their occurrence.

Section snippets

Specific Aims

Our aim was to describe aspiration events in mechanically ventilated adult patients with tracheostomies. Specifically, we aimed to use VF examinations to determine the incidence of aspiration, the frequency of silent aspirations, and to compare demographic and clinical characteristics between subjects who aspirated and those who did not aspirate.

Subjects

Study subjects were adult patients admitted to the Ventilator Support Center (VSC) at Suburban Hospital in Hinsdale, Ill between April 1988 and March

Subjects

Videotapes were reviewed on 83 ventilator-dependent patients: 44 (53 percent) women and 39 (47 percent) men. Subjects ranged in age from 21 to 94 years, with a mean age of 68.7 years. Causes of respiratory failure included chronic obstructive pulmonary disease, pneumonia, sepsis, neuromuscular disorders, cardiovascular failure, postoperative respiratory insufficiency, and cancer.

The mean duration of ventilator dependence was 112 days (range, 25 to 547 days). All patients had tracheostomy tubes,

Discussion

A major finding of this study is the frequency of aspirations of oral feedings in long-term ventilator-dependent patients. The 50 percent aspiration rate in the current study compares with an aspiration frequency detected by VF of 0 in normal subjects16 and 40 percent in patients in a rehabilitation hospital.13 To our knowledge, no other study has used VF to study aspiration in a population of intubated, mechanically ventilated patients. Studies of aspirations in intubated patients using dye

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revision accepted May 14.

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