Gastro-esophageal reflux in mechanically ventilated patients: The comprehensive “oil well” analogy

Mauricio Orozco-Levi


From a conceptual and clinical point of view, a comprehensive interpretation of risk factors leading to gastro-esophageal reflux (GER) is translated in this review into an “oil well” analogy: whereas gastric contents represent the oil deposit, groups of “on-off” events reflect the presence or absence of specific risk factors and events, respectively, similar to opening and closing a drilling tower. In this dynamic analogy for both the risk and magnitude of GER, we emphasize that generalization of GER risk factors in clinical settings is extremely relevant but fraught with complexity, difficulties and limitations. Therefore, the primary purpose of this review is to examine the effect of the interaction between body positioning, gastrointestinal function, tube feeding, drugs and additional factors on the aspiration risk in critically ill, tube-fed patients.


Intensive care, gastro-esophageal reflux, risk, mechanical ventilation, pneumonia, morbidity, mortality, prevention.

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