A SIMPLE AND NEW TEST FOR THE PREVENTION OF ASPIRATION PNEUMONIA IN TRACHEOTOMIZED ICU PATIENTS

[P-9112] A SIMPLE AND NEW TEST FOR THE PREVENTION OF ASPIRATION PNEUMONIA IN TRACHEOTOMIZED ICU PATIENTS Fausto Ferraro, MD, Fabio Rispoli, MD, Andrea Di Simone, MD, Roberta Regolo, MD, Emanuela Troise, MD, Francesca Ferrara, MD, Stellina Lanza, MD, Clara Belluomo Anello, MD. Seconda Università degli studi di Napoli, Napoli, Campania, Italy INTRODUCTION: Methylene blue (methylthionine chloride) is used to treat a condition called methemoglobinemia, caused by intoxications due to nitrite, nitrate and other substances. Methylene blue (MB) is also used to dye parts of human body (dysplastic and nondysplastic Barrett's esophagus and dysplasia of uterine cervix) or to detect stabs of fistulas (during surgery). Moreover, MB is used to treat plasma before the storage. In our ICU we have experienced a new diagnostic use of MB. This method detects the functionality of deglutition in tracheotomized ICU patients after removing noose-gastric sound and before feeding them by oral way to prevent aspiration pneumonia. OBJECTIVES: To reduce the incidence of aspiration pneumonia after removal the nose-gastric tube in tracheotomized adult ICU patients. MATERIALS AND METHODS: In our study we have considered a population of 138 tracheostomized ICU patients. In 72 patients we estimated the swallowing functionality by methylene blue test (MB group); 66 patients were the control group (nMB group). After removal the nose-gastric tube, the test was practiced at MB group's bedside. We administrated 50 ml of methylene blue solution 0,2% diluited in normal saline solution to patients in seated position. Deflated the tracheotomy tube cuff, the patients were invited to drink the solution from a “flaute spout” syringe or from a glass; continue aspiration sound was inserted through the tracheotomy tube. The blue coloration of the aspiration sound gave the positivity of the test. The test was repeated twice to each patient, to reduce false positive results. The positivity of the test has been determining for implantation of percutaneous endoscopic gastrostomy. The negativity of the test allowed as to feed patients by oral way. In nMB group we were used to remove the noose-gastric sound and to start feeding patients by oral way. RESULTS: In the nMB group we observed aspiration pneumonia in 4 patient. No case in the MB group. CONCLUSION: The use of this simple and safer test has reduced the aspiration pneumonia in tracheotomized patients of our ICU after removing the nose-gastric sound and feeding patients by oral way. REFERENCES : Stukenborg GJ,Wagner DP, Harrel FE Jr, Oliver MN, Kilbredge KL, Lyman J, Einbinder J, Connors AF Jr. Hospital discharge abstract data on comorbidity improved the prediction of death among patients hospitalized with aspiration pneumonia. J Clin Epidemiol. 2004; 57(5):522-32 Yukesekol I, Tasan Y, Ozkan M, Balkan A, Bicak M, Demirci N. Recurrent Aspiration Pneumonia and Barrett's Esophagus: A Case Report. Tuberk Toraks. 2003; 51(1):52-5 Date: Sunday, December 12, 2004 11:00 AM Session Info: Poster Presentation II (11:00 AM-1:00 PM) Presentation Time: 11:00 AM Room: Empire Complex, 7th Floor, New York Marriott Marquis