CI: Blue Dye Use (2006)

Study Design:
- Click here for explanation of classification scheme.
Quality Rating:
Research Purpose:

Consensus statement from the North American Summit on Aspiration in the Critically Ill Patient.

Inclusion Criteria:
Exclusion Criteria:
Description of Study Protocol:
Data Collection Summary:
Description of Actual Data Sample:
Summary of Results:

Methods to decrease risk of aspiration:

  • Post-pyloric feeding (beyond the Ligament of Treitz preferable) suggested by meta-analysis to show significant treatment effect in reducing aspiration pneumonia
  • Reassess need, level, and choice of agents for sedation
  • Reevaluate need for opiate analgesia
  • Elevate head of bead 30 degrees to 45 degrees. Place patient in reverse Trendelenberg at same angle.
  • Consider continuous infusion
  • Optimize oral health
  • Consider moving high-risk patients to monitored units
  • Prokinetic agents
  • Continuous aspiration of subglottic secretions
  • Kinetic beds.
Author Conclusion:
  • Major risk factors for aspiration include documented previous episode of aspiration, decreased level of consciousness, neuromuscular disease and structural abnormalities of the aerodigestive tract, endotracheal intubation, vomiting, persistently high gastric residual volumes and need for prolonged supine position
  • Additional risk factors include presence of nasoenteric tube, non-continuous or intermittent feeding, abdominal/thoracic surgery or trauma, delayed gastric emptying, poor oral care, age, inadequate nursing staff, large size or diameter of feeding tube, malpositioned feeding tube, transport
  • Use of blue food coloring is poorly standardized and has been shown to have low sensitivity for detecting aspiration
  • Cases of absorption of blue food coloring in critically ill patients have raised questions about safety. Benefits are poor and risks substantial. The practice should be abandoned.
Funding Source:
University/Hospital: University of Louisville School of Medicine, Nutrition services coram Healthcare
Reviewer Comments:
Quality Criteria Checklist: Review Articles
Relevance Questions
  1. Will the answer if true, have a direct bearing on the health of patients? Yes
  2. Is the outcome or topic something that patients/clients/population groups would care about? Yes
  3. Is the problem addressed in the review one that is relevant to dietetics practice? Yes
  4. Will the information, if true, require a change in practice? Yes
Validity Questions
  1. Was the question for the review clearly focused and appropriate? Yes
  2. Was the search strategy used to locate relevant studies comprehensive? Were the databases searched and the search termsused described? Yes
  3. Were explicit methods used to select studies to include in the review? Were inclusion/exclusion criteria specified andappropriate? Wereselectionmethods unbiased? Yes
  4. Was there an appraisal of the quality and validity of studies included in the review? Were appraisal methodsspecified,appropriate, andreproducible? Yes
  5. Were specific treatments/interventions/exposures described? Were treatments similar enough to be combined? Yes
  6. Was the outcome of interest clearly indicated? Were other potential harms and benefits considered? Yes
  7. Were processes for data abstraction, synthesis, and analysis described? Were they applied consistently acrossstudies and groups? Was thereappropriate use of qualitative and/or quantitative synthesis? Was variation in findings among studies analyzed? Were heterogeneity issued considered? If data from studies were aggregated for meta-analysis, was the procedure described? Yes
  8. Are the results clearly presented in narrative and/or quantitative terms? If summary statistics are used, are levels ofsignificance and/or confidence intervals included? Yes
  9. Are conclusions supported by results with biases and limitations taken into consideration? Are limitations ofthe review identified anddiscussed? Yes
  10. Was bias due to the review's funding or sponsorship unlikely? Yes