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A Journal on Anesthesiology, Resuscitation, Analgesia and Intensive Care
Minerva Anestesiologica 2013 September;79(9):1003-10
Tracheal amylase dosage as a marker for microaspiration: a pilot study
Filloux B. 1, Bedel A. 2, 3, Nseir S. 4, Mathiaux J. 5, Amadéo B. 6, Clouzeau B. 1, Pillot J. 1, Saghi T. 1, Vargas F. 1, Hilbert G. 1, Gruson D. 1, Boyer A. 1, 7 ✉
1 Medical Intensive Care Unit, CHU Bordeaux, Bordeaux, France;
2 Biochemistry Laboratory, CHU Bordeaux, Bordeaux, France;
3 Université de Bordeaux, Inserm U1035, Biothérapies des Maladies Genetiques et Cancers, Bordeaux, France;
4 Medical Intensive Care Unit, Hôpital Calmette, CHRU Lille, Lille, France;
5 Pulmonary Medicine Department, CHU Bordeaux, Bordeaux, France;
6 ISPED, Centre INSERM U897-Epidemiologie-Biostatistique, Université de Bordeaux, Bordeaux, France;
7 Université de Bordeaux, INSERM U657, Pharmaco-Epidémiologie et Evaluation de l’Impact des Produits de Santé sur les Populations, Bordeaux, France
Background: Devices that limit microaspiration through the cuffs of endotracheal tubes could help prevent ventilator-associated pneumonia (VAP). The amount of tracheal microaspirations could be a relevant study endpoint. The aim of our study was to assess whether amylase measured in tracheal secretions constituted a relevant marker for microaspiration.
Methods: Twenty-six patients, intubated for at least 48 h and supplied with a subglottic secretion-suctioning device, constituted a group with a high risk of microaspiration. Twelve non-ventilated patients that required a bronchoscopy procedure constituted a group with a low risk of microaspiration (the control group). Tracheal (T) amylase was compared between the groups. In the intubated group, a series of oral (O), subglottic (Sg) and tracheal (T) suction samples were collected and T/O, T/Sg, Sg/O amylase ratios were determined.
Results: Amylase was measured in 277 (89 Sg, 96 B, 92 T) samples from the intubated group and in 12 T samples from the control group. Tracheal amylase was lower in the control group than the intubated group (191 [10–917] vs. 6661 [2774–19,358] IU/L, P<0.001). Amylase gradually increased from tracheal (6661 [2774-19,358] IU/L), to subglottic (130,750 [55,257-157,717] IU/L), to oral samples (307,606 [200,725-461,300] IU/L), resulting in a median 5.5% T/O ratio. In a subset of intubated patients, T amylase samples were assessed in two different laboratories, and gave reproducible results.
Conclusion: Tracheal amylase was easy to collect, transport, and measure. The T/O amylase ratio is a first step towards quantifying oropharyngeal to tracheal microaspiration in mechanically-ventilated patients.