Potts R G, Zaroukian M H, Guerrero P A, Baker C D
Department of Medicine, Michigan State University College of Human Medicine, East Lansing.
Chest. 1993 Jan;103(1):117-21. doi: 10.1378/chest.103.1.117.
To compare the relative utility of blue dye visualization with a glucose oxidase test strip method for detecting aspiration of enteral feedings.
Tracheally intubated adults were prospectively monitored for aspiration of enteral feedings.
Intensive care units of two community hospitals in Michigan.
None.
The experimental group consisted of 15 patients receiving enteral feedings. The control group included 14 patients not enterally fed.
Blue food coloring was added to feeding formulas to obtain a visible blue color. At 8-h intervals, tracheal secretions were examined for blue discoloration, followed by measurement of glucose concentration using a calibrated glucose meter. Clinically significant aspiration was defined to require the following: (1) a bloodless positive glucose reading (> or = 20 mg/dl); (2) one or more signs of systemic inflammation; and (3) one or more signs of respiratory deterioration. Eight (53 percent) of 15 patients in the experimental group experienced at least one episode of presumptive aspiration as defined by either a bloodless positive glucose reading or visible blue discoloration of tracheal secretions. Clinically significant aspiration occurred in 5 (33 percent) of 15 patients in whom bloodless glucose readings were positive in 13 (19 percent) of 67 samples; among patients not developing this complication, glucose was found in only 3 (5 percent) of 60 samples; (p = 0.005). Inspecting tracheal secretions for blue dye usually failed to detect aspiration episodes identifiable by the glucose oxidase test strip method (relative sensitivity, 13 percent). Blue dye visualization performed no better among patients developing clinically significant aspiration (relative sensitivity, 15 percent). Patients who developed clinically significant aspiration received more of their enteral feedings in the supine position than patients without this complication (98 percent vs 21 percent; p < 0.001).
Inspecting tracheal secretions for blue discoloration failed to detect most episodes of enteral feeding aspiration. Glucose oxidase test strip methods should replace blue dye visualization for detecting aspiration of enteral feedings in intubated adults.
比较蓝色染料可视化法与葡萄糖氧化酶试纸法在检测肠内营养误吸方面的相对效用。
对气管插管的成年患者进行前瞻性监测，观察肠内营养误吸情况。
密歇根州两家社区医院的重症监护病房。
无。
实验组由15例接受肠内营养的患者组成。对照组包括14例未接受肠内营养的患者。
向喂养配方中添加蓝色食用色素，使其呈现可见的蓝色。每隔8小时检查气管分泌物是否有蓝色变色，随后使用校准血糖仪测量葡萄糖浓度。具有临床意义的误吸定义为需要满足以下条件：（1）血糖读数呈无血阳性（≥20mg/dl）；（2）一种或多种全身炎症体征；（3）一种或多种呼吸恶化体征。实验组15例患者中有8例（53%）经历了至少一次根据无血血糖阳性读数或气管分泌物可见蓝色变色定义的疑似误吸事件。15例患者中有5例（33%）发生了具有临床意义的误吸，其中67份样本中有13份（19%）血糖读数呈无血阳性；在未发生该并发症的患者中，60份样本中仅有3份（5%）检测到葡萄糖；（p = 0.005）。通过检查气管分泌物中的蓝色染料通常无法检测到葡萄糖氧化酶试纸法可识别的误吸事件（相对灵敏度为13%）。在发生具有临床意义误吸的患者中，蓝色染料可视化法的表现也没有更好（相对灵敏度为15%）。发生具有临床意义误吸的患者仰卧位接受肠内营养的比例高于无此并发症的患者（98%对21%；p < 0.001）。
检查气管分泌物中的蓝色变色无法检测到大多数肠内营养误吸事件。葡萄糖氧化酶试纸法应取代蓝色染料可视化法用于检测插管成年患者的肠内营养误吸。
