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Gastroesophageal Reflux in Critically Ill Patients

Schallom, Marilyn MSN, RN, CCRN, CCNS; Orr, James PhD; Metheny, Norma PhD, RN, FAAN; Pierce, Janet DSN, APRN, CCRN

Dimensions of Critical Care Nursing: March/April 2013 - Volume 32 - Issue 2 - p 69–77
doi: 10.1097/DCC.0b013e318280836b
Clinical DIMENSION

Gastroesophageal reflux (GER) is a common occurrence in critically ill, mechanically ventilated patients. Reflux can lead to pulmonary aspiration of gastric contents and subsequent pneumonia. Several characteristics of patients, interventions provided in the intensive care unit setting, and factors associated with feeding increase a patient’s risk for reflux. Critical care nurses and clinical nurse specialists can identify patients at highest risk for GER by utilizing the patient’s history, reviewing the medications, and assessing the current status to provide interventions to reduce the risk of GER and its sequelae of aspiration pneumonia. This article reviews the physiology of GER, risk factors, and interventions to decrease GER in the critically ill patient.

Gastroesophageal reflux is a common problem in patients receiving mechanical ventilation.This article discusses the pathophysiology of gastroesophageal reflux, risk factors, and medical and nursing interventions to decrease the incidence of this common problem.

Marilyn Schallom, MSN, RN, CCRN, CCNS, is a clinical nurse specialist in the Department of Research at Barnes-Jewish Hospital at Washington University and is a doctoral nursing student at the University of Kansas, School of Nursing.

James Orr, PhD, is a professor in the Department of Molecular Bioscience at the University of Kansas.

Norma Metheny, PhD, RN, FAAN, is the associate dean of research at St Louis University. Dr Metheny has researched extensively in the field of pulmonary aspiration associated with gastric feedings.

Janet Pierce, DSN, APRN, CCRN, is a professor of nursing at the University of Kansas.

The authors have disclosed that they have no significant relationship with, or financial interest in, any commercial companies pertaining to this article.

Address correspondence and reprint requests to: Marilyn Schallom, MSN, RN, CCRN, CCNS, One Barnes-Jewish Hospital Plaza, MS 90-59-346, St Louis, MO 63110 (mes4143@bjc.org).

© 2013 Lippincott Williams & Wilkins, Inc.