Ventilatör Ilişkili Pnömoni ile Gastroözofageal Reflü ve Trakeabronşial Aspirasyon Arasındaki Ilişki

Abstract

Background: Gastroesophageal reflux (GER) and microaspiration of gastric contents has been proposed as an important mechanism in the pathogenesis of ventilator associated pneumonia (VAP) but properties of GER in intensive care unit (ICU) and how these effect VAP is not completely elucidated. Aim: This study aims to assess the association between GER and VAP by defining the proximal extension and chemical properties of GER and its association with gastropulmonary microaspiration in intubated patients. Methods: Intubated patients in ICU were included in this study. Patients who had pneumonia at the time of intubation or who were diagnosed with pneumonia during the first 48 hours after intubation were excluded. Pepsin measurements were made on samples obtained by deep tracheal aspiration (DTA) and a combined esophageal intraluminal impedance/pHmetry catheters were placed. Impedance/pH values and pepsin levels were compared between VAP and nonVAP patients. Results: VAP patients had more proximal reflux ((7 (2 – 14) vs. 3,5 (0 – 8)) (p=0,003). Proximal weakly acidic reflux was more common in VAP patients (4,5 (2 - 9) vs 2 (0 - 4) (p=0,006). Pepsin levels in DTA samples were correlated with total weakly acidic reflux (r=0,615 , p=0,004) Pepsin levels were also correlated with total proximal and proximal weakly acidic reflux(r=0,489 , p=0,029 ; r=0,651 , p=0,002 ). PaO2/FiO2 ratio was negatively correlated with both pepsin levels and proximal weakly acidic reflux (r= - 0,585 , p=0,007 ; r=- 0,620 , p=0,004). Conclusion: Proximal extension of GER, especially proximal weakly acidic reflux, was more common among VAP patients and this was associated with pepsin levels in DTAs as a marker of gastropulmonary microaspiration. GER also seems to be negatively correlated with respiratoy function in intubated patients.