North American Summit on Aspiration in the Critically Ill Patient: Consensus Statement

• Published in: JPEN. Journal of parenteral and enteral nutrition Vol. 26; no. 6_suppl; pp. S80 - S85
• Main Authors: McClave, Stephen A., DeMeo, Mark T., DeLegge, Mark H., DiSario, James A., Heyland, Daren K., Maloney, James P., Metheny, Norma A., Moore, Frederick A., Scolapio, James S., Spain, David A., Zaloga, Gary P.
• Format: Journal Article Conference Proceeding
• Language: English
• Published: Thousand Oaks, CA SAGE Publications 01.11.2002; ASPEN; American Society for Parenteral and Enteral Nutrition
• Subjects: Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Critical Illness - therapy; Emergency and intensive care: metabolism and nutrition disorders. Enteral and parenteral nutrition; Enteral Nutrition - adverse effects; Humans; Inhalation - physiology; Intensive care medicine; Medical sciences; North America; Pneumonia, Aspiration; North America; America; Human; Lung disease; Intensive care; Terminology; Respiratory disease; Critically ill; Method; Algorithm; Trauma; Recommendation; Enteral administration; Feeding; Prevention; Consensus conference; Aspiration pneumonia; Risk factor; Complication; Diagnosis; Monitoring
• ISSN: 0148-6071; 1941-2444
• DOI: 10.1177/014860710202600613

Aspiration is the leading cause of pneumonia in the intensive care unit and the most serious complication of enteral tube feeding (ETF). Although aspiration is common, the clinical consequences are variable because of differences in nature of the aspirated material and individual host responses. A number of defense mechanisms normally present in the upper aerodigestive system that protect against aspiration become compromised by clinical events that occur frequently in the critical care setting, subjecting the patient to increased risk. The true incidence of aspiration has been difficult to determine in the past because of vague definitions, poor assessment monitors, and varying levels of clinical recognition. Standardization of terminology is an important step in helping to define the problem, design appropriate research studies, and develop strategies to reduce risk. Traditional clinical monitors of glucose oxidase strips and blue food coloring (BFC) should no longer be used. A modified approach to use of gastric residual volumes and identification of clinical factors that predispose to aspiration allow for risk stratification and an algorhythm approach to the management of the critically ill patient on ETF. Although the patient with confirmed aspiration should be monitored for clinical consequences and receive supportive pulmonary care, ETF may be continued when accompanied by appropriate steps to reduce risk of further aspiration. Management strategies for treating aspiration pneumonia are based on degree of diagnostic certainty, time of onset, and host factors. ( Journal of Parenteral and Enteral Nutrition26:S80-S85, 2002)