Detection of aspiration in enterally fed patients: a requiem for bedside monitors of aspiration.
BACKGROUND
Pulmonary aspiration of gastric and oropharyngeal contents is common in enterally fed patients. Detection of early aspiration in these patients has relied on clinical impression, the coloring of enteral feedings with dyes, and less commonly the detection of elevated glucose in tracheal aspirates. The potential benefits, risks, and clinical use of bedside monitors of aspiration are under increasing scrutiny.


METHODS
Literature review. Although this review reflects the opinions of the authors, recommendations of an expert consensus panel (North American Summit on Aspiration, which included one author, J. P. Maloney) were also used to guide recommendations. The specific recommendations of that panel are presented elsewhere.


RESULTS
No large prospective clinical trials have been done to evaluate the use and safety of bedside monitors for aspiration. Clinical impression remains a poor "gold standard" of aspiration diagnosis in enterally fed patients. The coloring of enteral feedings with blue dyes (chiefly FD&C Blue No.1) is ubiquitous in hospitals despite evidence that it is not sensitive and potentially harmful. Cases of absorption of blue dye from enteral feedings in patients with critical illness have raised concern about the safety of the blue dye method, particularly in light of apparent toxic effects of these dyes on mitochondria. The glucose detection method has not been embraced; it too has little use and is labor intensive.


CONCLUSIONS
Use of colored dyes in enteral feedings and glucose detection methods should be abandoned. Nonrecumbent positioning is an evidenced-based method for aspiration prevention that needs to be re-emphasized. Novel bedside methods of detecting early aspiration are needed to supplement preventative strategies.
Maloney
James P
JP
Division of Pulmonary and Critical Medicine and Cardiovascular Research Center, Medical College of Wisconsin, Milwaukee 53226, USA. jmaloney@mcw.edu
Ryan
Tracey A
TA
D004750:Enteral Nutrition / Q000009:adverse effects*; D006801:Humans; D001239:Inhalation / Q000502:physiology*; D011015:Pneumonia, Aspiration / Q000517:prevention & control*; D019095:Point-of-Care Systems