Q: 72 years old male with a recent stroke and now s/p tracheostomy is recovering in ICU, and awaiting long-term care transfer. Patient is also getting tube feed. Respiratory therapist (RT) reports possible "feeding material" in tracheal suction. What is the quickest way to ascertain tracheal aspiration of tube feed?
Answer: Check the glucose level of the tracheal aspirate
One quick method of suspecting tracheal aspiration is to check glucose concentration with regular bedside glucose meters. A glucose concentration of more than 20 mg/dl of bloodless tracheal aspirate highly enhances the suspicion of tracheal aspiration.
Though evidence is not very strong for this procedure in the literature, at least it makes clinicians to be vigilant.
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References:
1. Clinical implications of the glucose test strip method for early detection of pulmonary aspiration in nasogastric tube- fed patients - Taehan Kanho Hakhoe Chi. 2004 Dec;34(7):1215-23
2. Comparison of blue dye visualization and glucose oxidase test strip methods for detecting pulmonary aspiration of enteral feedings in intubated adults - Chest, Vol 103, 117-121
3. Glucose content of tracheal aspirates: Implications for the detection of tube feeding aspiration. Crit Care Med 1994; 22:1557-1562
4. Glucose Content of Tracheal Aspirates - Letter to the Editor - Critical Care Medicine: Volume 23(8) August 1995 pp 1451-1452
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