title: Pepsin and amylase in oral and tracheal secretions: a pilot study.
abstract: 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 long-term outcomes was not assessed, findings indicate that microaspiration of oral and gastric secretions occurs frequently.
authors.affiliation: Mary Lou Sole is Orlando Health Distinguished Professor, University of Central Florida, and a research scientist at Orlando Health, Orlando, Florida. Janet Conrad is a clinical scientist in the pediatric specialty diagnostic laboratory and Devendra Indulal Mehta is the director of the pediatric gastroenterology laboratory, Arnold Palmer Hospital for Children, Orlando, Florida. Melody Bennett is a member of the adjunct faculty, University of Central Florida, and a staff nurse at Orlando Health. Aurea Middleton is a staff nurse at Orlando Health. Katherine Hay is a staff nurse at University of Alabama at Birmingham, Birmingham, Alabama. Suzanne Ashworth is a clinical nurse specialist in neurological critical care, Orlando Regional Medical Center, Orlando, Florida. mary.sole@ucf.edu.
authors.forename: Mary Lou
authors.initials: ML
authors.lastname: Sole
authors.affiliation: Mary Lou Sole is Orlando Health Distinguished Professor, University of Central Florida, and a research scientist at Orlando Health, Orlando, Florida. Janet Conrad is a clinical scientist in the pediatric specialty diagnostic laboratory and Devendra Indulal Mehta is the director of the pediatric gastroenterology laboratory, Arnold Palmer Hospital for Children, Orlando, Florida. Melody Bennett is a member of the adjunct faculty, University of Central Florida, and a staff nurse at Orlando Health. Aurea Middleton is a staff nurse at Orlando Health. Katherine Hay is a staff nurse at University of Alabama at Birmingham, Birmingham, Alabama. Suzanne Ashworth is a clinical nurse specialist in neurological critical care, Orlando Regional Medical Center, Orlando, Florida.
authors.forename: Janet
authors.initials: J
authors.lastname: Conrad
authors.affiliation: Mary Lou Sole is Orlando Health Distinguished Professor, University of Central Florida, and a research scientist at Orlando Health, Orlando, Florida. Janet Conrad is a clinical scientist in the pediatric specialty diagnostic laboratory and Devendra Indulal Mehta is the director of the pediatric gastroenterology laboratory, Arnold Palmer Hospital for Children, Orlando, Florida. Melody Bennett is a member of the adjunct faculty, University of Central Florida, and a staff nurse at Orlando Health. Aurea Middleton is a staff nurse at Orlando Health. Katherine Hay is a staff nurse at University of Alabama at Birmingham, Birmingham, Alabama. Suzanne Ashworth is a clinical nurse specialist in neurological critical care, Orlando Regional Medical Center, Orlando, Florida.
authors.forename: Melody
authors.initials: M
authors.lastname: Bennett
authors.affiliation: Mary Lou Sole is Orlando Health Distinguished Professor, University of Central Florida, and a research scientist at Orlando Health, Orlando, Florida. Janet Conrad is a clinical scientist in the pediatric specialty diagnostic laboratory and Devendra Indulal Mehta is the director of the pediatric gastroenterology laboratory, Arnold Palmer Hospital for Children, Orlando, Florida. Melody Bennett is a member of the adjunct faculty, University of Central Florida, and a staff nurse at Orlando Health. Aurea Middleton is a staff nurse at Orlando Health. Katherine Hay is a staff nurse at University of Alabama at Birmingham, Birmingham, Alabama. Suzanne Ashworth is a clinical nurse specialist in neurological critical care, Orlando Regional Medical Center, Orlando, Florida.
authors.forename: Aurea
authors.initials: A
authors.lastname: Middleton
authors.affiliation: Mary Lou Sole is Orlando Health Distinguished Professor, University of Central Florida, and a research scientist at Orlando Health, Orlando, Florida. Janet Conrad is a clinical scientist in the pediatric specialty diagnostic laboratory and Devendra Indulal Mehta is the director of the pediatric gastroenterology laboratory, Arnold Palmer Hospital for Children, Orlando, Florida. Melody Bennett is a member of the adjunct faculty, University of Central Florida, and a staff nurse at Orlando Health. Aurea Middleton is a staff nurse at Orlando Health. Katherine Hay is a staff nurse at University of Alabama at Birmingham, Birmingham, Alabama. Suzanne Ashworth is a clinical nurse specialist in neurological critical care, Orlando Regional Medical Center, Orlando, Florida.
authors.forename: Katherine
authors.initials: K
authors.lastname: Hay
authors.affiliation: Mary Lou Sole is Orlando Health Distinguished Professor, University of Central Florida, and a research scientist at Orlando Health, Orlando, Florida. Janet Conrad is a clinical scientist in the pediatric specialty diagnostic laboratory and Devendra Indulal Mehta is the director of the pediatric gastroenterology laboratory, Arnold Palmer Hospital for Children, Orlando, Florida. Melody Bennett is a member of the adjunct faculty, University of Central Florida, and a staff nurse at Orlando Health. Aurea Middleton is a staff nurse at Orlando Health. Katherine Hay is a staff nurse at University of Alabama at Birmingham, Birmingham, Alabama. Suzanne Ashworth is a clinical nurse specialist in neurological critical care, Orlando Regional Medical Center, Orlando, Florida.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Ash-worth
authors.affiliation: Mary Lou Sole is Orlando Health Distinguished Professor, University of Central Florida, and a research scientist at Orlando Health, Orlando, Florida. Janet Conrad is a clinical scientist in the pediatric specialty diagnostic laboratory and Devendra Indulal Mehta is the director of the pediatric gastroenterology laboratory, Arnold Palmer Hospital for Children, Orlando, Florida. Melody Bennett is a member of the adjunct faculty, University of Central Florida, and a staff nurse at Orlando Health. Aurea Middleton is a staff nurse at Orlando Health. Katherine Hay is a staff nurse at University of Alabama at Birmingham, Birmingham, Alabama. Suzanne Ashworth is a clinical nurse specialist in neurological critical care, Orlando Regional Medical Center, Orlando, Florida.
authors.forename: Devendra Indulal
authors.initials: DI
authors.lastname: Mehta
mesh_terms: D000681:Amylases / Q000032:analysis*; D004750:Enteral Nutrition; D005260:Female; D005750:Gastric Juice / Q000201:enzymology; D006801:Humans; D007442:Intubation, Intratracheal / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D009055:Mouth / Q000201:enzymology / Q000378:metabolism*; D010434:Pepsin A / Q000032:analysis*; D010865:Pilot Projects; D011015:Pneumonia, Aspiration / Q000209:etiology; D012121:Respiration, Artificial / Q000009:adverse effects; D063466:Respiratory Aspiration of Gastric Contents / Q000209:etiology; D013396:Suction; D014132:Trachea / Q000201:enzymology / Q000378:metabolism*
chemical_list: D000681:Amylases; D010434:Pepsin A