ArticleAmerican journal of critical care : an official publication, American Association of Critical-Care Nurses2021
Pepsin A in Tracheal Secretions From Patients Receiving Mechanical Ventilation.
Article in American journal of critical care : an official publication, American Association of Critical-Care Nurses, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers, 1 of them a synthesis that pooled it.
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
6 citing papers in PubMed, 1 synthesis or guideline pooled it, 8 citations in OpenAlex.
- Association Between Daily Toothbrushing and Hospital-Acquired Pneumonia: A Systematic Review and Meta-Analysis.JAMA internal medicine · 2024Pooled it
- Continuous versus intermittent cuff pressure monitoring in preventing ventilator-associated pneumonia: a multicentre randomised controlled trial.Antimicrobial resistance and infection control · 2025Trial
- Beyond the Lungs: ICU Oral Care and Gut Resilience-A Hypothesis-Generating Narrative Review.Microorganisms · 2026Review
- Use of Machine Learning Models to Predict Microaspiration Measured by Tracheal Pepsin A.American journal of critical care : an official publication, American Association of Critical-Care Nurses · 2025Article
- Machine learning predictive model for aspiration risk in early enteral nutrition patients with severe acute pancreatitis.Heliyon · 2024Article
- Association of enteral feeding with microaspiration in critically ill adults.Applied nursing research : ANR · 2022Article
Corrections and comments
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Authors and funding
7 authors at 5 institutions in 2 countries.
Funding
Abstract
backgroundIn patients in the intensive care unit (ICU) receiving mechanical ventilation, aspiration of gastric contents may lead to ventilator-associated events and other adverse outcomes. Pepsin in pulmonary secretions is a biomarker of microaspiration of gastric contents.
objectivesTo evaluate the association between tracheal pepsin A and clinical outcomes related to ventilator use.
methodsA subset of 297 patients from a larger clinical trial on aspiration of oral secretions in adults receiving mechanical ventilation consented to have pepsin A measured in their tracheal aspirate samples. A concentration ≥6.25 ng/mL indicated a positive result. Abundant microaspiration was defined as pepsin A in ≥30% of samples. Statistical analyses included analysis of variance, analysis of covariance, and χ2 tests.
resultsMost patients were White men, mean age 59.7 (SD, 18.8) years. Microaspiration was found in 43.8% of patients (n = 130), with abundant microaspiration detected in 17.5% (n = 52). After acuity was controlled for, patients with tracheal pepsin A had a longer mechanical ventilation duration (155 vs 104 hours, P < .001) and ICU stay (9.9 vs 8.2 days, P = .04), but not a longer hospital stay.
conclusionsMicroaspiration of gastric contents occurred in nearly half of patients and was associated with a longer duration of mechanical ventilation and a longer stay in the ICU. Additional preventative interventions beyond backrest elevation, oropharyngeal suctioning, and management of endotracheal tube cuff pressure may be needed. Also, the timing of pepsin measurements to capture all microaspiration events requires additional exploration.
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