Aspiration of gastric contents can cause complications such as pneumonia in critically ill, mechanically ventilated patients who use feeding tubes. In this study, Metheny and colleagues compared the risk of aspiration in ventilator users following the Aspiration Risk-Reduction Protocol (ARRP) (n = 145) with those receiving usual care (no standard procedures for reducing aspiration risk) (n = 329) for 3 days. The ARRP involved keeping a 30[degrees] or greater head-of-bed elevation, inserting a feeding tube into the distal portion of the small bowel (when requested by a physician), and using an algorithmic approach to high gastric residual volumes during feedings. An advanced practice nurse began training ICU staff in this protocol two months before study initiation, providing counseling, reinforcement, and monthly feedback on its implementation.

Significantly fewer patients in the ARRP group than in the usual care group experienced aspiration (12% versus 31%, respectively). Patients in the usual care group were twice as likely as those in the ARRP group to aspirate at least once. Nearly half (48%) of the usual care group experienced pneumonia compared with only 19% of the ARRP group.

The authors concluded that a multifaceted approach to risk reduction can decrease aspiration incidence in intubated patients receiving tube feedings. They noted that the training and guidance of the advanced practice nurse was integral to the success of the risk-reduction protocol.-SDSJ