Oropharyngeal aspiration in pediatric patients with endotracheal intubation*

Objective To determine the prevalence and factors associated with oropharyngeal aspiration in pediatric patients submitted to mechanical ventilation and endotracheal intubation. Design Prospective cross-sectional study. Setting Four pediatric intensive care units. Patients Fifty infants and children with endotracheal intubation submitted to mechanical ventilation. Interventions Aspiration was determined by administering Evans blue dye in the oral cavity and searching the dye agent in the specimens obtained from two tracheal aspirates performed at 5- and 30-min intervals. During this period, the frequency of swallowing movements was continuously monitored using surface electromyography (biofeedback). The association between aspiration and age, sedation level, mean airway pressure, swallowing dynamics, and intubation route was tested using the chi-square and relative risk (95% confidence interval). Results also were adjusted by multivariate analysis. Measurements and Main Results The overall prevalence of aspi-ration was 28% (n = 14). At the univariate analysis, aspiration was associated with sedation level (p = .03), frequency of swallowing movements (p = .0003), and orotracheal route (p = .03). The relative risk (95% confidence interval) for aspiration was 2.92 (1.32–6.42) in patients considered to be inadequately sedated (Hartwig 8–18); 14.08 (1.99–99.67) in patients presenting frequent swallowing (>30 movements in 30 mins); and 5.57 (0.8–38.85) in patients with orotracheal intubation. The multivariate analysis identified that the orotracheal route (p = .03) and frequent swallowing movements (p = .0007) were independently associated with aspiration. Conclusions Aspiration around the tracheal tube is a frequent finding (28%) in children undergoing mechanical ventilation. The frequent swallowing movements and the orotracheal intubation route were significantly associated with aspiration. These results suggest that the nasotracheal intubation route could be recommended as the first choice for reducing this potential clinical complication.