Miao Pingping, Zhang Yan, Zhong Ailing
Department of Critical Care Medicine, Hai'an People's Hospital, Hai'an, China.
J Thorac Dis. 2023 May 30;15(5):2585-2600. doi: 10.21037/jtd-23-430. Epub 2023 May 8.
Elderly intensive care unit (ICU) patients represent a high-risk group of aspiration. Different feeding patterns will lead to different incidences of aspiration. However, there are few studies on the risk factors of aspiration in elderly ICU patients under different feeding patterns. The aim of this study was to analyze the effects of different eating styles on the occurrence of overt and silent aspiration in elderly ICU patients and to compare the independent risk factors, in order to provide a basis for targeted aspiration prevention.
We retrospectively analyzed the incidence of aspiration in elderly patients admitted to the ICU from April 2019 to April 2022, a total of 348 cases. The patients were divided into the oral feeding group, gastric tube feeding group, and post-pyloric feeding group according to their feeding method. Multi-factor logistic regression was used to analyze the independent risk factors for overt and silent aspiration caused by the different eating patterns of patients.
Among the 348 elderly ICU patients included, the overall incidence of aspiration was 72%, with a 22% rate of overt aspiration and a 49% rate of silent aspiration. The overt aspiration rates were 16%, 30%, and 21% in the oral, the gastric tube and the post-pyloric feeding group, respectively; while the silent aspiration rates were 52%, 55%, and 40% in the three groups, respectively. Multiple logistic regression analysis showed that the independent risk factors for both overt and silent aspiration were history of aspiration [odds ratio (OR) =0.075, P=0.004; OR =0.205, P=0.042] and gastrointestinal tumor (OR =0.100, P=0.028; OR =0.063, P=0.003) in the oral feeding group. In the gastric tube feeding group, the independent risk factor for both overt and silent aspiration was the history of aspiration (OR =4.038, P=0.040; OR =4.658, P=0.012). In the post-pyloric feeding group, the independent risk factors for both overt and silent aspiration were mechanical ventilation (OR =0.211, P=0.019; OR =0.336, P=0.037) and intra-abdominal hypertension (OR =0.225, P=0.020; OR =0.329, P=0.032).
There were significant differences in the influencing factors and characteristics of aspiration among the elderly patients in the ICU with different feeding patterns. Personalized precautions should be implemented early, so as to reduce the possibility of aspiration.
老年重症监护病房（ICU）患者是误吸的高危人群。不同的喂养方式会导致不同的误吸发生率。然而，关于不同喂养方式下老年ICU患者误吸危险因素的研究较少。本研究旨在分析不同进食方式对老年ICU患者显性和隐性误吸发生情况的影响，并比较其独立危险因素，为针对性的误吸预防提供依据。
回顾性分析2019年4月至2022年4月入住ICU的348例老年患者的误吸发生率。根据喂养方式将患者分为经口喂养组、鼻饲组和幽门后喂养组。采用多因素logistic回归分析患者不同进食方式导致显性和隐性误吸的独立危险因素。
在纳入的348例老年ICU患者中，误吸总发生率为72%，其中显性误吸率为22%，隐性误吸率为49%。经口喂养组、鼻饲组和幽门后喂养组的显性误吸率分别为16%、30%和21%；隐性误吸率分别为52%、55%和40%。多因素logistic回归分析显示，经口喂养组显性和隐性误吸的独立危险因素均为误吸史[比值比（OR）=0.075，P=0.004；OR =0.205，P=0.042]和胃肠道肿瘤（OR =0.100，P=0.028；OR =0.063，P=0.003）。鼻饲组显性和隐性误吸的独立危险因素均为误吸史（OR =4.038，P=0.040；OR =4.658，P=0.012）。幽门后喂养组显性和隐性误吸的独立危险因素均为机械通气（OR =0.211，P=0.019；OR =0.336，P=0.037）和腹腔内高压（OR =0.225，P=0.020；OR =0.329，P=0.032）。
不同喂养方式的老年ICU患者误吸的影响因素和特点存在显著差异。应尽早实施个性化预防措施，以降低误吸的可能性。
