{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T23:05:58Z","timestamp":1785884758438,"version":"3.56.0"},"reference-count":41,"publisher":"AACN Publishing","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,11,1]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>In patients in the intensive care unit (ICU) receiving mechanical ventilation, aspiration of gastric contents may lead to ventilator-associated events and other adverse outcomes. Pepsin in pulmonary secretions is a biomarker of microaspiration of gastric contents.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>To evaluate the association between tracheal pepsin A and clinical outcomes related to ventilator use.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>A subset of 297 patients from a larger clinical trial on aspiration of oral secretions in adults receiving mechanical ventilation consented to have pepsin A measured in their tracheal aspirate samples. A concentration \u22656.25 ng\/mL indicated a positive result. Abundant microaspiration was defined as pepsin A in \u226530% of samples. Statistical analyses included analysis of variance, analysis of covariance, and \u03c72 tests.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Most patients were White men, mean age 59.7 (SD, 18.8) years. Microaspiration was found in 43.8% of patients (n = 130), with abundant microaspiration detected in 17.5% (n = 52). After acuity was controlled for, patients with tracheal pepsin A had a longer mechanical ventilation duration (155 vs 104 hours, P &amp;lt; .001) and ICU stay (9.9 vs 8.2 days, P = .04), but not a longer hospital stay.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Microaspiration of gastric contents occurred in nearly half of patients and was associated with a longer duration of mechanical ventilation and a longer stay in the ICU. Additional preventative interventions beyond backrest elevation, oropharyngeal suctioning, and management of endotracheal tube cuff pressure may be needed. Also, the timing of pepsin measurements to capture all microaspiration events requires additional exploration.<\/jats:p>\n               <\/jats:sec>","DOI":"10.4037\/ajcc2021528","type":"journal-article","created":{"date-parts":[[2021,11,1]],"date-time":"2021-11-01T02:02:08Z","timestamp":1635732128000},"page":"443-450","source":"Crossref","is-referenced-by-count":8,"title":["Pepsin A in Tracheal Secretions From Patients Receiving Mechanical Ventilation"],"prefix":"10.4037","volume":"30","author":[{"given":"Steven","family":"Talbert","sequence":"first","affiliation":[{"name":"Steven Talbert is interim director of the nursing PhD program and a clinical assistant professor, University of Central Florida College of Nursing, Orlando, Florida."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annette M.","family":"Bourgault","sequence":"additional","affiliation":[{"name":"Annette M. Bourgault is an associate professor, University of Central Florida College of Nursing and a nurse scientist, Orlando Health, Orlando, Florida."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kimberly Paige","family":"Rathbun","sequence":"additional","affiliation":[{"name":"Kimberly Paige Rathbun is a graduate research assistant, University of Central Florida College of Nursing."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bassam","family":"Abomoelak","sequence":"additional","affiliation":[{"name":"Bassam Abomoelak is a senior research associate, Pediatric Specialty Diagnostic Laboratory, Arnold Palmer Hospital, Orlando, Florida."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chirajyoti","family":"Deb","sequence":"additional","affiliation":[{"name":"Chirajyoti Deb is a senior research associate, Pediatric Specialty Diagnostic Laboratory."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Devendra","family":"Mehta","sequence":"additional","affiliation":[{"name":"Devendra Mehta is a pediatric gastroenterologist, Pediatric Specialty Diagnostic Laboratory."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary Lou","family":"Sole","sequence":"additional","affiliation":[{"name":"Mary Lou Sole is dean, professor, and Orlando Health Endowed Chair in Nursing, University of Central Florida College of Nursing and clinical scientist, Orlando Health."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2471","reference":[{"issue":"4","key":"2021110102020138600_b1-0300443","doi-asserted-by":"crossref","first-page":"413","DOI":"10.2174\/187152611796504827","article-title":"Microaspiration in intubated critically ill patients: diagnosis and prevention","volume":"11","author":"Nseir","year":"2011","journal-title":"Infect Disord Drug Targets"},{"key":"2021110102020138600_b2-0300443","doi-asserted-by":"crossref","first-page":"83","DOI":"10.2174\/1874306401812010083","article-title":"Gastric aspiration and its role in airway inflammation","volume":"12","author":"Hunt","year":"2018","journal-title":"Open Respir Med J"},{"issue":"6","key":"2021110102020138600_b3-0300443","first-page":"725","article-title":"The pathogenesis of ventilator-associated pneumonia: its relevance to developing effective strategies for prevention","volume":"50","author":"Safdar","year":"2005","journal-title":"Respir Care"},{"key":"2021110102020138600_b4-0300443","unstructured":"Centers for Disease Control and Prevention\n          . 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