Impact of Deep Oropharyngeal Suctioning on Microaspiration, Ventilator Events, and Clinical Outcomes: A Randomized Clinical Trial.

Aims To evaluate a deep oropharyngeal suction intervention (NO-ASPIRATE) in intubated patients on microaspiration, ventilator-associated events and clinical outcomes. Design Prospective, two-group, single-blind, randomized clinical trial. Methods The study was conducted between 2014 - 2017 in 513 participants enroled within 24 hr of intubation and randomized into NO-ASPIRATE or usual care groups. Standard oral care was provided to all participants every 4 hr and deep oropharyngeal suctioning was added to the NO-ASPIRATE group. Oral and tracheal specimens were obtained to quantify alpha-amylase as an aspiration biomarker. Results Data were analysed for 410 study completers enrolled at least 36 hr: NO-ASPIRATE (N = 206) and usual care (N = 204). Percent of tracheal specimens positive for alpha-amylase, mean tracheal alpha-amylase levels over time and ventilator-associated events were not different between groups. The NO-ASPIRATE group had a shorter hospital length of stay and a subgroup with moderate aspiration at baseline had significantly lower alpha-amylase levels across time. Conclusion Hospital length of stay was shorter in the NO-ASPIRATE group and a subgroup of intervention participants had lower alpha-amylase across time. Delivery of standardized oral care to all participants may have been an intervention itself and possibly associated with the lack of significant findings for most outcomes. Impact This trial compared usual care to oral care with a deep suctioning intervention on microaspiration and ventilator-associated events, as this has not been systematically studied. Further research on the usefulness of alpha-amylase as an aspiration biomarker and the role of oral suctioning, especially for certain populations, is indicated. Trial registration number: ClinicalTrials.gov: NCT00654321.