Category Ranking
98%
Total Visits
921
Avg Visit Duration
2 minutes
Citations
20
Article Abstract
Background: Microaspiration of gastric and oropharyngeal secretions is the main mechanism of entry of bacteria into the lower respiratory tract in intubated critically ill patients. The aim of this study is to determine the impact of enteral nutrition, as compared with parenteral nutrition, on abundant microaspiration of gastric contents and oropharyngeal secretions.
Methods: Planned ancillary study of the randomized controlled multicenter NUTRIREA2 trial. Patients with shock receiving invasive mechanical ventilation were randomized to receive early enteral or parenteral nutrition. All tracheal aspirates were collected during the 48 h following randomization. Abundant microaspiration of gastric contents and oropharyngeal secretions was defined as the presence of significant levels of pepsin (> 200 ng/ml) and salivary amylase (> 1685 UI/ml) in > 30% of tracheal aspirates.
Results: A total of 151 patients were included (78 and 73 patients in enteral and parenteral nutrition groups, respectively), and 1074 tracheal aspirates were quantitatively analyzed for pepsin and amylase. Although vomiting rate was significantly higher (31% vs 15%, p = 0.016), constipation rate was significantly lower (6% vs 21%, p = 0.010) in patients with enteral than in patients with parenteral nutrition. No significant difference was found regarding other patient characteristics. The percentage of patients with abundant microaspiration of gastric contents was significantly lower in enteral than in parenteral nutrition groups (14% vs 36%, p = 0.004; unadjusted OR 0.80 (95% CI 0.69, 0.93), adjusted OR 0.79 (0.76, 0.94)). The percentage of patients with abundant microaspiration of oropharyngeal secretions was significantly higher in enteral than in parenteral nutrition groups (74% vs 54%, p = 0.026; unadjusted OR 1.21 (95% CI 1.03, 1.44), adjusted OR 1.23 (1.01, 1.48)). No significant difference was found in percentage of patients with ventilator-associated pneumonia between enteral (8%) and parenteral (10%) nutrition groups (HR 0.78 (0.26, 2.28)).
Conclusions: Our results suggest that enteral and parenteral nutrition are associated with high rates of microaspiration, although oropharyngeal microaspiration was more common with enteral nutrition and gastric microaspiration was more common with parenteral nutrition.
Trial Registration: ClinicalTrials.gov, NCT03411447 . Registered 18 July 2017. Retrospectively registered.
Download full-text PDF |
Source |
|---|---|
| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6451282 | PMC |
| http://dx.doi.org/10.1186/s13054-019-2403-z | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Provider Attitudes and Perceptions on Using Artificial Intelligence in Colonoscopy: A Systematic Review and Meta-Analysis.
Gastro Hep Adv
July 2025
Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine at UCLA, Los Angeles, California.
Background And Aims: Colonoscopy is the gold standard screening modality for colorectal cancer; however, it is operator-dependent and reliant on exam quality. Incorporating artificial intelligence (AI) into colonoscopy may improve adenoma detection and clinical outcomes, but this is a sociotechnical challenge that requires effective human-AI teaming incorporating provider attitudes.
Methods: We conducted a systematic review of studies evaluating attitudes and perspectives of providers toward AI-assisted colonoscopy.
Variceal Hemorrhage as Complication of Vascular Access for Total Parenteral Nutrition.
ACG Case Rep J
October 2024
Division of Gastroenterology, Hepatology, and Nutrition, University of Louisville, Louisville, KY.
Downhill varices, a rare manifestation of venous hypertension, arise from superior vena cava (SVC) obstruction. We present a unique case of downhill varices secondary to SVC syndrome in a 69-year-old man on chronic total parenteral nutrition who presented with large volume melena and facial swelling. In this case, chronic central venous catheter use contributed to thrombotic occlusion of the SVC, leading to collateral vessel formation and variceal development.
View Article and Find Full Text PDFWhere comfort and nutrition meet: A case series of children with severe neurologic impairment receiving home parenteral nutrition at the end of life.
Nutr Clin Pract
September 2025
Department of Pediatrics, Mayo Clinic, Rochester, Minnesota, USA.
Home parenteral nutrition (HPN) is a life-sustaining therapy traditionally used as a bridge to enteral autonomy or intestinal transplantation. Increasingly, it is used for intractable feeding intolerance (IFI), which can occur near the end of life (EOL) in children with severe neurological impairment (SNI). In these cases, HPN use differs from its historical role and requires tailored outpatient planning.
View Article and Find Full Text PDFAssociation between mixed oil lipid emulsions and all-cause infections relative to soybean oil lipid emulsions in hospitalized adults: A retrospective cohort study.
JPEN J Parenter Enteral Nutr
September 2025
Division of Gastroenterology, Department of Medicine, Toronto General Hospital, University of Toronto, University Health Network, Toronto, Ontario, Canada.
Background: Intravenous lipid emulsions are a key component of parenteral nutrition, and their fatty acid compositions may influence immune responses and clinical outcomes.
Methods: This retrospective cohort study conducted from January 2020 to December 2022 compared clinical outcomes of hospitalized non-critical care patients receiving parenteral nutrition with either mixed oil or soybean oil lipid emulsions for at least 48 h. The primary outcome was a composite of the presence of pneumonia, urinary tract infection, or an intra-abdominal collection diagnosed within 14 days of initiating parenteral nutrition.
Teicoplanin total trough concentration and adverse effects in patients with hypoalbuminemia.
J Infect Chemother
September 2025
Department of Pharmacy, NHO Kyushu Medical Center, 1-8-1 Jigyouhama, Chuo-ku, Fukuoka 810-8563, Japan.
Background: The association between Teicoplanin (TEIC) total trough concentration (C) and adverse effects (hepatotoxicity, nephrotoxicity, and thrombocytopenia) in patients with hypoalbuminemia remains poorly understood. We examined this association for patients with hypoalbuminemia from a safety perspective.
Methods: This retrospective study included adult patients (≥18 years) who received TEIC at Kyushu Medical Center between April 2013 and March 2024, underwent therapeutic drug monitoring, and had persistent serum albumin < 2.