PULMONARY ASPIRATION IN MECHANICALLY VENTILATED PATIENTS WITH TRACHEOSTOMIES

The purpose of this descriptive study was to evaluate feeding aspirati ons in adult patients receiving long-term mechanical ventilatory suppo rt, including the incidence of aspirations, the frequency of silent (c linically inapparent) aspirations, and differences between aspirators and nonaspirators. Aspiration data were determined by review of videof luoroscopic (VF) tapes of modified barium swallow procedures performed on 83 medically stable patients admitted to a chronic ventilator unit . Demographic and clinical variables were obtained from review of subj ects' medical records. Forty-two subjects (50 percent) aspirated durin g VP testing and 37 of 48 (77 percent) aspirations were silent. Subjec ts who aspirated were significantly older than those who did not aspir ate (p = 0.007). Swallowing disorders were common, particularly distur bances of the pharyngeal phase. We conclude that feeding aspiration is seen frequently in patients with tracheostomies receiving prolonged p ositive pressure mechanical ventilation. Advanced age increases the ri sk of aspiration in this population. Episodes of aspiration are not co nsistently accompanied by clinical symptoms of distress to alert the b edside observer to their occurrence.