Detection of pepsin and glucose in tracheal secretions as indicators of aspiration in mechanically ventilated children

Meert, Kathleen L.; Daphtary, Kshama; Metheny, Norma A.

doi:10.1097/00130478-200201000-00005

Cited by 32 publications

(30 citation statements)

References 18 publications

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“…In keeping with our findings, pepsin detection in throat sputum has been suggested to be a sensitive and non-invasive diagnostic method for laryngopharyngeal reflux [20]. Our study supports previous studies on the identification of pepsin in airway secretions for the diagnosis of laryngopharyngeal reflux [26,27,28,29]. Pepsin was detected mainly in the samples collected at the time of symptoms (n = 18).…”

Section: Discussionsupporting

confidence: 91%

Pepsin Detection in the Sputum/Saliva for the Diagnosis of Gastroesophageal Reflux Disease in Patients with Clinically Suspected Atypical Gastroesophageal Reflux Disease Symptoms

Kim¹,

Lee²,

Yeo³

et al. 2008

Digestion

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Background/Aims: Atypical manifestations of gastroesophageal reflux disease (GERD) are diverse. We aimed to determine whether pepsin detection in the sputum/saliva could be useful for diagnosing GERD in patients with clinically suspected atypical GERD symptoms. Methods: Patients with clinically suspected atypical GERD symptoms provided sputum/saliva collected before bedtime, at the time of those symptoms, and after awakening for pepsin measurement by Western blot analysis. All subjects received 24-hour esophageal pH monitoring, and then 40 mg of esomeprazole was given twice a day for 2 weeks. Results: The pepsin test was positive in 20 out of 40 patients, with pepsin detected mainly in the samples collected at the time of symptoms (45%). Samples collected from healthy volunteers (n = 8) were all negative for pepsin. 24-hour pH-metry was positive in 9 patients (23%). Based on 24-hour pH-metry data, the sensitivity and negative predictive value of the pepsin test were excellent in most of typical and atypical symptom groups, whereas its specificity and positive predictive value were relatively low, particularly in atypical symptom groups. Conclusions: Pepsin measurement in the sputum/saliva collected at the time of symptoms provides a sensitive, non-invasive method for diagnosing GERD in patients with clinically suspected atypical GERD symptoms.

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Section: Discussionsupporting

confidence: 91%

Pepsin Detection in the Sputum/Saliva for the Diagnosis of Gastroesophageal Reflux Disease in Patients with Clinically Suspected Atypical Gastroesophageal Reflux Disease Symptoms

Kim¹,

Lee²,

Yeo³

et al. 2008

Digestion

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“…Additional modifications of our laboratory procedures to detect lower levels of amylase are warranted; however, the values we obtained were similar to those reported for patients receiving mechanical ventilation who had risk factors for aspiration and infections. 5,7,8 Our findings are consistent with those of other reports 5,6,[8][9][10][11][12]14,[26][27][28][29][30][31][32][33][34][35][36] of pepsin and amylase as biomarkers of microaspiration. Dewavrin and colleagues 36 argue that the use of amylase is only moderately accurate in diagnosing microaspiration.…”

Section: Discussionsupporting

confidence: 92%

Pepsin and Amylase in Oral and Tracheal Secretions: A Pilot Study

Sole¹,

Conrad²,

Bennett³

et al. 2014

American Journal of Critical Care

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worth, RN, MSN, CCRN, CCNS, and Devendra Indulal Mehta, MBBS, MSc(dist), MRCP Background Endotracheal intubation increases the risk for microaspiration of secretions around the tube cuff. Pepsin has been used as a biomarker for gastric aspiration. Amylase is a newer proposed biomarker for aspiration of oral contents. Objective To assess the presence of pepsin and amylase in paired oral-tracheal secretions of adult patients treated with mechanical ventilation. Methods In this descriptive study, paired samples of oral and tracheal secretions were obtained from adult patients at baseline and again within 4 hours when a need for endotracheal suctioning was assessed. Assays of pepsin and amylase were processed in a specialty diagnostic laboratory. Results The sample consisted of 10 men and 3 women with a median age of 56 years. The majority were intubated with a subglottic suction endotracheal tube (9 patients, 69%), receiving synchronized intermittent mandatory ventilation (10 patients; 77%), and receiving enteral feedings (11 patients; 85%) through a tube distally placed in the stomach (8 patients; 67%). Pepsin was present in oral secretions of 9 patients (69%), and in tracheal specimens of 7 patients (54%) at one or both sampling times. Amylase was detected in all patients' oral secretions and in tracheal secretions of 5 patients (38%) at one or both sampling times. Conclusions Many patients had pepsin, amylase, or both in tracheal aspirates. Pepsin was more commonly detected than was amylase. Although the relationship of this finding to longterm outcomes was not assessed, findings indicate that microaspiration of oral and gastric secretions occurs frequently.

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“…However, as shown in their study, it was possible to detect intracellular milk proteins only during the first 4 d following aspiration. Recently, Metheny and colleagues demonstrated that aspiration of gastric content could be detected by a specific pepsin immunoassay in tube-fed adults (24) and children (25) receiving mechanical ventilation and in an experimental model in rabbits (26). Although the technique is very sensitive for the diagnosis of aspiration secondary to gastroesophageal reflux, it does not detect aspiration from above due to disturbances such as swallowing mechanism dysfunction.…”

Section: Discussionmentioning

confidence: 99%

Poly-lactic-glycolic Acid Microspheres: A Biodegradable Marker for the Diagnosis of Aspiration in Hamsters

et al. 2005

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Detection of pepsin and glucose in tracheal secretions as indicators of aspiration in mechanically ventilated children

Cited by 32 publications

References 18 publications

Pepsin Detection in the Sputum/Saliva for the Diagnosis of Gastroesophageal Reflux Disease in Patients with Clinically Suspected Atypical Gastroesophageal Reflux Disease Symptoms

Pepsin Detection in the Sputum/Saliva for the Diagnosis of Gastroesophageal Reflux Disease in Patients with Clinically Suspected Atypical Gastroesophageal Reflux Disease Symptoms

Pepsin and Amylase in Oral and Tracheal Secretions: A Pilot Study

Poly-lactic-glycolic Acid Microspheres: A Biodegradable Marker for the Diagnosis of Aspiration in Hamsters

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