Daily evaluation of macroaspiration in the critically ill post-trauma patient.
BACKGROUND
Although critically ill trauma patients represent a high-risk population for macroaspiration, studies of trauma patients have not been explored. The study aims were to quantify rate and associated risks of macroaspiration and explore the pattern of antibiotic use and incidence of aspiration pneumonia within this patient group.


METHODS
Consecutive trauma patients admitted to the intensive care unit (ICU) were prospectively observed for development of macroaspiration and subsequent aspiration pneumonia. Daily monitoring included chart review, laboratory and radiography results, and nurse inquiries for witnessed macroaspiration events.


RESULTS
Seven of 60 patients included experienced a clinically confirmed macroaspiration event (11.7%). The incidence of pneumonia was similar, regardless of macroaspiration occurrence (28.6%: macroaspiration cases vs 17.0%: controls, p > or = 0.05). Patients with macroaspiration required a longer duration of mechanical ventilation (15 vs 9.5 days, p = 0.021) and intensive care unit stay (28 vs 7 days, p = 0.015). Paralytic agent utilization was associated with an increased risk for aspiration (p = 0.045).


CONCLUSIONS
The incidence of macroaspiration within a critically ill trauma population may be less frequent compared with studies performed in other patient populations. Although macroaspiration was associated with a longer duration of mechanical ventilation and intensive care unit stay, this condition may not be associated with an increased rate of pulmonary infection.
Miller
Christopher D
CD
Department of Surgery, Division of Trauma and Critical Care, Fletcher Allen Health Care, 111 Colchester Avenue, Burlington, VT 05401, USA.
Rebuck
Jill A
JA
Ahern
John W
JW
Rogers
Frederick B
FB
D000328:Adult; D017677:Age Distribution; D000368:Aged; D015331:Cohort Studies; D016638:Critical Illness; D005260:Female; D005500:Follow-Up Studies; D015600:Glasgow Coma Scale; D006801:Humans; D015994:Incidence; D015601:Injury Severity Score; D007362:Intensive Care Units; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D009104:Multiple Trauma / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D011015:Pneumonia, Aspiration / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology*; D011336:Probability; D011446:Prospective Studies; D018570:Risk Assessment; D017678:Sex Distribution; D018709:Statistics, Nonparametric; D015996:Survival Rate; D013997:Time Factors