Which of the following is a major risk factor for aspiration in critically ill patients?

• A. Gastric residual volume < 150 mL
• B. Decreased level of consciousness
• C. Age
• D. Small diameter feeding tube

Answer: (B)

Decreased level of consciousness compromises the body's airway defenses. When a patient is sedated or otherwise not fully awake, the cough and gag reflexes, plus the coordinated swallowing that protects the airway during feeding, are blunted. This makes it much easier for oropharyngeal secretions, refluxed gastric contents, or feed to enter the trachea and lungs, leading to aspiration. In the critically ill, sedation, delirium, analgesia, or neurologic injury amplify this risk, and even with enteral feeding, aspiration can occur from microaspiration around the endotracheal or airway devices or from regurgitated contents. The other factors listed do not inherently raise aspiration risk to the same extent: age alone isn’t a major driver, a small-diameter tube or a relatively low gastric residual volume don’t by themselves indicate a high aspiration risk when feeding is managed appropriately.