The Southern Medical Journal (SMJ) is the official, peer-reviewed journal of the Southern Medical Association. It has a multidisciplinary and inter-professional focus that covers a broad range of topics relevant to physicians and other healthcare specialists.

SMJ // Article

Original Article

Open Access: ICU-Broncho-Aspiration Protocols Monitoring at an Academic Health Network System

Authors: Araceli Cuaranta, MD, Michael Abdelmasseh, MD, MPH, Calyb King, BS, Alex Ashley, BS, Jeremy Eckles, BS, Juan Hernandez-Pelcastre, BS, Tania Nguyen, BS, Nic Tate, BS, Chase Gillispie, BS, Joshua Keefer, BS, Levi Nolan, BS, Errington Thompson, MD, Robert Finley, MD, Barbara Payne, RN, OCN, CCRP, Alexei Gorka, BS, BA, Jonathan Willis, MS, Vineela Kadiyala, MSCS, Juan Sanabria, MD, MSc

Abstract

Objectives: The objectives were to determine intensive care unit (ICU) incidence of broncho-aspiration (BA) and the effect of monitoring BA prevention protocols.

Methods: The Health Network Warehouse was interrogated for the diagnosis of BA in patients older than 18 years in the surgical ICU (SICU) from January 2010 to December 2020. A BA prevention bundle protocol was prospectively monitored during all consecutive SICU admissions from August 2021 to November 2021 until discharge/death (n = 159). Experimental subjects were matched for age, sex, body mass index, and comorbidities with historical controls (BA− and BA+) as a propensity score analysis study. The BA prevention bundle protocol consisted of head-of-bed elevation at 30°, acid-suppressive medication, and daily administration of mouthwash. Univariate/multivariate analyses were conducted (P < 0.05).

Results: The BA incidence over a 10-year period was 5.6%. Before study initiation, random monitoring showed a mean bundle protocol compliance of 29% (18%–39%). After the introduction of protocol monitoring, compliance increased to 92% despite an upsurge in temporary nurses serving in the ICU. There was a total of 795 daily entries, with a mean head-of-bed elevation of 29.8° ± 13°, and a 10-fold decrease in BA (from 5.6% to 0.6%, P < 0.01).

Conclusions: Implementation and monitoring of a BA prevention protocol significantly reduced the rate of BA in the SICU.

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