Prevention Of Aspiration In Adults :silhouette: (Minimizing…
Prevention Of Aspiration In Adults :silhouette:
Aspiration in the Tube-fed Patient
Critically ill patients that are tube fed may require prokinetic agents to increase gastric intestinal motility to accelerate the emptying into the small bowel.
To reduce aspiration of stomach contents patients may receive small bowel feedings which bypasses the stomach and prevent reflux.
Patients are at risk for aspiration if they are sedated or on paralytic agents.
Assessment of gastric residual volume is essential to ensure appropriate absorption of the feeding, and to prevent over feeding, which can lead to reflux into the lungs.
SITUP is a three part screening tool that includes assessing for signs of impaired swallowing and psychomotor activity, and a swallowing evaluation.
This research found a decreased incidence of aspiration pneumonia with adherence to the SITUP protocol.
Oropharyngeal dysphagia screening is a primary tool associated with reducing the risk of aspiration pneumonia.
Head of Bed Elevation in Critically Ill Patients
Maintaining the head of bed at forty-five degrees is preferred to reduce the risk of aspiration in mechanically vented patients.
Despite the research findings elevated HOB is not consistently applied in the critical care setting.
For critically ill patients who are not vented or tube feed it is recommended to maintain a HOB of thirty degrees.
The Role of Endotracheal Tube Cuff in Microaspiration
Properly inflating the endotracheal cuff reduces the occurrence of microaspiration in critically ill patients, and needs to be determined on an individual basis.
An appropriately inflated cuff prevents air and/or liquids from escaping around the cuff and entering the lungs.
An improperly inflated cuff leave patient at increased risk for microaspiration which can lead to hypoxia and respiratory infections.
Aspiration pneumonia is typically the result of microaspiration of oropharynx, nasopharynx, upper gastrointestinal, or subglottic contents which can contain infectious aspirated contents.
Intervention that can be implemented to reduce the risk of aspiration pneumonia include: proper oral care to reduce bacteria in the mouth, increased sedation awareness, and dietary interventions.
The severity of aspiration is dependent on volume, pH, infectious organisms in aspirate, acuity of onset of clinical symptoms, and the internal defenses of the patient.