비위관영양환자의 폐흡인 조기확인을 위한 포도당 검사지[glucose test strips] 방법의 임상적 유용성

Clinical Implications of the Glucose Test Strip Method for Early Detection of Pulmonary Aspiration in Nasogastric Tube- Fed Patients

  • 발행 : 2004.12.01

초록

Purpose: This study was performed to test the clinical usefulness of the glucose test strip method for early detection of pulmonary aspiration in tube fed patients. Method: The subjects for the study were 36 patients who were receiving enteral feedings and 39 patients who were not given enteral feedings. For the analysis, the tube fed patients were divided into two groups (clinically significant aspiration and no aspiration) according to criteria. Result: The mean glucose concentration of tracheal secretions from non enteral fed patients was 26.35mg/dl and were lower than those concentrations found in tube fed patients (32.75mg/dl). The mean glucose concentration of the aspiration group was 45.60mg/dl and the glucose concentration of the non aspiration group was 19.93mg/dl. The difference was statistically significant (t=2.163, p=.038). More subjects in the no aspiration group ($73\%$) than the aspiration group ($56\%$) had glucose concentrations below 20mg/dl. After deleting the cases that had samples containing blood, glucose concentrations of tracheal aspirates were lower in both groups. Conclusion: The glucose level of the aspiration group was significantly lower than the no aspiration group and more subjects in the aspiration group had a glucose level higher than 101mg/dl. Therefore, the glucose test of tracheal secretions in tube fed patients could be a desirable test for screening for tracheal aspiration. Especially the patient who is showing repeatedly high glucose levels should not be given feedings until reassessment is completed.

키워드

참고문헌

  1. Boat, T. F., & Matthews, L. W. (1973). Chemical composition of human tracheobronchial secretions. In Dulfano, MF(ed.) Sputum: Fundamentals and Clinical Pathology. Springfield, Illinois: Thomas, C. C. 197-205
  2. Day, L, Stotts, N. A., Frankfurt, A., Stralovich-Romani, A., Volz, M., Muwaswes, M., Fukuoka, Y., & O'Leary-Kelley, C. (2001). Gastric versus duodenal feeding in patients with neurological disease: a pilot study. J. Neurosci Nurs, 33(3), 148-149, 155-159, 166
  3. DeLegge, M. (2002). Aspiration pneumonia: incidence, mortality, and at-risk populations JPEN, 26(6), S19-S25
  4. Elpern, E. H., Jacobs, E. R., Tangney, C. C., & Bone, R. C. (1986). Nonspecificity of glucose reagent strips as a marker of formula feeding aspiration(abstract). Am Rev Respir Dis, 131, A288
  5. Esparaz, J., Boivin, M. A., Hartshorne, M. F., & Levy, H. (2001). Equal aspiration rates in gastrically and transpylorically fed critically ill patients. Intensive Care Med, 27(4), 660-664
  6. Heyland, D., Drover, J., MacDonald, S., Novak, F., & Lam, M. (2001). Effect of postpyloric feeding on gastroesophageal regurgitation and pulmonary microaspiration: results of randomized controlled trial. Crit Care Med, 29(8), 1495-1501
  7. Jeejeebhoy, K. N. (2002). Enteral feeding. Curr opin clin nutr and meta care, 5(6), 695-698
  8. Kim, J. K., Lim, O. K., Yim, Y. M., Kim, D. H., & Kim, J. T. (2001). Dextrose swallowing test to detect aspiration for patient with tracheostomy. J. Korean Acad Rehavil Med, 25(6), 923-927
  9. Kim, K. S., Kim, D. S., Kang, W. J., Choi, Y. K., Shin, O. Y., Lee, D. I., & Kwon, M. I. (1999). Incidence of pulmonary aspiration in patients with tracheostomy. Korean Crit Care Med, 14(2), 161-166
  10. Kinsey, G., Murray, M. J., Swensen, S. J., & Miles, J. M. (1995). Glucose content of tracheal aspirates: implication for the detection of tuve feeding aspiration. Crit Care Med, 22, 1557-1562
  11. Lazarus, B. A., Murphy, J. B., & Culpepper, L. (1990). Aspiration associated with long-term gastric vs. jejunal feeding. A critical analysis of the literature. Arch Phys Med Rehavil, 71, 46-51
  12. McClave, S., DeMeo, M., DeLegge, M., DiSario, J., Heyland, K., Maloney, J., Metheny, N., Moore, F., Scolapio, J., Spain, D., & Zaloga, G. (2002). North American summit on aspiration in the critically ill patient: Consensus Statement. JPEN, 26:S80-S85
  13. MaClave, S., & Snider, J. (2002). Clinical use of gastric residual volumes as a monitor for patients on enteral tube feeding. JPEN, 26(6), S43-S50
  14. Maloney, P., Ryan, T., Brasel, K. J., Binion, D. G., Johnson, D. R., Halbower, A. C., Frankel, E. H., Nyffeler, M., & Moss, M. (2002). Food dye use in enteral feedings: A review and a call for a moratorium. JPEN, 17(3), 169-181
  15. Metheny, N. (2002). Risk factors for aspiration. JPEN, 26(6), S26-S33
  16. Metheny. N. A., Aud, M. A., & Wunderlich, R. J. (1999). A survey of bedside methods used to detect pulmonary aspiration of enteral formula in intubated tube-fed patients. Am J Crit Care, 8, 160-167
  17. Pancorbo-Hidalgo, P. L., Garca-Fernandez, F. P., & Ramrez-Prez, C. (2001). Complications associated with enteral nutrition by nasogastric tube in an internal medicine unit. J Clin Nurs, 10(4), 482-490
  18. Potts, R., Zaroukian, M. Guerrero, P., & Baker, C. (1993). Comparison of blue dye visualization and glucose oxidase test strip methods for detecting pulmonary aspiration of enteral feedings in intubated adults. Chest, 103(1), 117-121
  19. St. John, R., Lefrak, S., Ridoffi, G., & Bohlman, P. (1985). Pulmonary aspiration of continuous formula feeding during mechanical ventilation(abstract). Am Rev Respir Dis, 132, A163
  20. Tugrul, S., Selkoglu, E., Ozcan, P.E., Akinci, O., Esen, F., Telci, L., Akpir, K., & Cakar., N. (2002). Is jejunal feeding efficient in critically ill patients?. Turkish J Trauma & Emerg Surg, 8(1), 16-21
  21. Taylor, H. M. (2002). Pneumonia frequencies with different enteral tube feeding access sites. Am J Men Retard, 107(3), 175-180
  22. Winterbauer, R., Durning, R., Barron, E., & McFadden, M. C. (1981). Aspirated nasogastric feeding solution detected by glucose strips. Ann Intern Med, 95, 67-68
  23. Young, P. J. (2001). A spoonful of sugar: improving the sensitivity of the glucose oxidase test strip method for detecting subclinical pulmonary aspiration of enteral feed. Anaesth Intensive Care, 29, 539-543