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Pan D, Chung S, Nielsen E, Niederman MS. Aspiration Pneumonia. Semin Respir Crit Care Med 2024; 45:237-245. [PMID: 38211629 DOI: 10.1055/s-0043-1777772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Abstract
Aspiration pneumonia is a lower respiratory tract infection that results from inhalation of foreign material, often gastric and oropharyngeal contents. It is important to distinguish this from a similar entity, aspiration with chemical pneumonitis, as treatment approaches may differ. An evolving understanding of the human microbiome has shed light on the pathogenesis of aspiration pneumonia, suggesting that dysbiosis, repetitive injury, and inflammatory responses play a role in its development. Risk factors for aspiration events involve a complex interplay of anatomical and physiological dysfunctions in the nervous, gastrointestinal, and pulmonary systems. Current treatment strategies have shifted away from anaerobic organisms as leading pathogens. Prevention of aspiration pneumonia primarily involves addressing oropharyngeal dysphagia, a significant risk factor for aspiration pneumonia, particularly among elderly individuals and those with cognitive and neurodegenerative disorders.
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Affiliation(s)
- Di Pan
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Samuel Chung
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Erik Nielsen
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Michael S Niederman
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Weill Cornell Medical College, New York, New York
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Nunley DR, Gualdoni J, Ritzenthaler J, Bauldoff GS, Howsare M, Reynolds KG, van Berkel V, Roman J. Evaluation of Donor Lungs for Transplantation: The Efficacy of Screening Bronchoscopy for Detecting Donor Aspiration and Its Relationship to the Resulting Allograft Function in Corresponding Recipients. Transplant Proc 2023; 55:1487-1494. [PMID: 37438192 DOI: 10.1016/j.transproceed.2023.03.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 03/11/2023] [Indexed: 07/14/2023]
Abstract
BACKGROUND Potential organ donors often have suffered anoxic and/or traumatic brain injury during which they may have experienced aspiration of gastric material (AGM). Evaluation of such donors typically includes a screening bronchoscopic examination during which determinations of aspiration are made. The efficacy of this visual screening and its relationship to post-transplant allograft function are unknown. METHODS Before procurement, bronchoscopy was performed on donors in which both bronchoalveolar lavage fluid (BALF) was collected and a visual inspection made. As a marker of AGM, BALF specimens were analyzed for the presence of bile salts. Data collected on the corresponding recipients included primary graft dysfunction (PGD) score, post-transplant spirometry, acute rejection scores (ARS), and overall survival. RESULTS Of 31 donors evaluated, bronchoscopies revealed only 2 with visual evidence of AGM, whereas BALF analysis for bile salts indicated AGM in 14. As such, screening bronchoscopy had a sensitivity of only 7.1%. Visual detection of AGM via bronchoscopy was not associated with any resulting grade of PGD (χ2 = 2.96, P = .23); however, AGM defined by detection of bile salts was associated (χ2 = 7.56, P = .02). Over the first post-transplant year, the corresponding recipients experienced a similar improvement in allograft function (χ2 = 1.63, P = .69), ARS (P = .69), and survival (P = .24). CONCLUSION Visual inspection during a single bronchoscopic examination of lung donors underestimates the prevalence of AGM. The detection of bile salts in donor BALF is associated with early allograft dysfunction in the corresponding recipients but not with later allograft proficiency, acute rejection responses, or 1-year post-transplant survival.
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Affiliation(s)
- David R Nunley
- Division of Pulmonary, Critical Care and Sleep Medicine, The Ohio State University College of Medicine, Columbus, Ohio.
| | - Jill Gualdoni
- Division of Pulmonary, Critical Care and Sleep Disorders Medicine, The University of Louisville School of Medicine, Louisville, Kentucky
| | - Jeffrey Ritzenthaler
- Division of Pulmonary, Allergy and Critical Care Medicine, Sidney Kimmel College of Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania
| | | | - Molly Howsare
- Division of Pulmonary, Critical Care and Sleep Medicine, The Ohio State University College of Medicine, Columbus, Ohio
| | - Karen G Reynolds
- Division of Pulmonary, Critical Care and Sleep Disorders Medicine, The University of Louisville School of Medicine, Louisville, Kentucky
| | - Victor van Berkel
- The University of Louisville College of Medicine, Louisville, Kentucky
| | - Jesse Roman
- The Ohio State University College of Nursing, Columbus, Ohio
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3
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Mine K, Mori H. Diffuse Aspiration Bronchiolitis With Neuromyelitis Optica Spectrum Disorder. Cureus 2023; 15:e38429. [PMID: 37273346 PMCID: PMC10234073 DOI: 10.7759/cureus.38429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2023] [Indexed: 06/06/2023] Open
Abstract
Diffuse aspiration bronchiolitis (DAB) is a chronic inflammatory response of the bronchioles caused by repeated aspiration of foreign bodies. It is common among older individuals with dysphagia associated with neurological diseases or dementia. Here, we present the case of a woman in her 40s who was presumed to have developed DAB due to neuromyelitis optica spectrum disorder (NMOSD). There have been no reports of DAB due to NMOSD. The absence of obvious episodes of aspiration and the fact that pneumonia was the predominant symptom delayed the diagnosis despite the appearance of specific neurological abnormalities. DAB caused by neurological diseases of the brainstem should be considered in younger patients with diffuse centrilobular opacities, even if dysphagia is not obvious.
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Affiliation(s)
- Keisuke Mine
- Department of Respiratory Medicine, Second Department of Internal Medicine, Nagasaki University, Nagasaki, JPN
| | - Hideki Mori
- General Internal Medicine, National Hospital Organization Nagasaki Medical Center, Omura, JPN
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Feng HY, Zhang PP, Wang XW. Presbyphagia: Dysphagia in the elderly. World J Clin Cases 2023; 11:2363-2373. [PMID: 37123321 PMCID: PMC10131003 DOI: 10.12998/wjcc.v11.i11.2363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 02/08/2023] [Accepted: 03/22/2023] [Indexed: 04/06/2023] Open
Abstract
Dysphagia has been classified as a “geriatric syndrome” and can lead to serious complications that result in a tremendous burden on population health and healthcare resources worldwide. A characteristic age-related change in swallowing is defined as “presbyphagia.” Medical imaging has shown some changes that seriously affect the safety and efficacy of swallowing. However, there is a general lack of awareness of the effects of aging on swallowing function and a belief that these changes are part of normal aging. Our review provides an overview of presbyphagia, which has been a neglected health problem for a long time. Attention and awareness of dysphagia in the elderly population should be strengthened, and targeted intervention measures should be actively implemented.
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Affiliation(s)
- Hai-Yang Feng
- School of Rehabilitation Medicine, Weifang Medical University, Weifang 261021, Shandong Province, China
| | - Ping-Ping Zhang
- School of Rehabilitation Medicine, Weifang Medical University, Weifang 261021, Shandong Province, China
| | - Xiao-Wen Wang
- School of Rehabilitation Medicine, Weifang Medical University, Weifang 261021, Shandong Province, China
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Kumar NR, Norwood BS. Sphingomonas Paucimobilis Pneumonia Complicated by Empyema in an Immunocompetent Patient: A Case Report and Concise Review of Literature. Cureus 2022; 14:e24820. [PMID: 35693369 PMCID: PMC9172810 DOI: 10.7759/cureus.24820] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2022] [Indexed: 11/25/2022] Open
Abstract
Sphingomonas paucimobilis is an aerobic, Gram-negative bacterium that is found widely in the environment and on hospital equipment. Although this organism usually causes infection in immunocompromised patients, it may cause pulmonary disease in immunocompetent patients, in rare cases. We report a case of Sphingomonas paucimobilis pneumonia complicated by empyema in an immunocompetent patient. We present a case of a 59-year-old female who was admitted for a congestive heart failure exacerbation and pneumonia. After imaging confirmed pneumonia and pleural effusion, monotherapy with levofloxacin was started. Thoracentesis revealed empyema caused by Sphingomonas paucimobilis. Despite chest tube placement, thoracoscopy with decortication was required due to continued clinical deterioration. After surgical intervention and an adjusted antibiotic regimen of cefepime, the patient clinically improved and was discharged. Upon follow-up, she had recovered completely with no residual disease. Alongside a concise review of the literature, our study highlights the importance of this infection in immunocompetent patients and advises providers to identify causes of aspiration when Sphingomonas paucimobilis empyema is diagnosed.
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Zhang Q, Xu W, Peng F, Lei S, Zhong Y, Yi J, Wu S. Case Report: Next-Generation Sequencing in Diagnosis of Atypical Aspiration Pneumonia. Front Public Health 2022; 9:771154. [PMID: 35059377 PMCID: PMC8764309 DOI: 10.3389/fpubh.2021.771154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 12/06/2021] [Indexed: 12/04/2022] Open
Abstract
Since the pandemic of Corona Virus Disease 2019 (COVID-19), especially in the centers most affected, the symptoms such as fever, cough, myalgia or fatigue, and radioactive signs typically related to COVID-19 like ground-glass opacity (GGO) often distract the attention of physicians from other diseases. Aspiration pneumonia and COVID-19 share similarities in some aspects. There may be risk of misdiagnosis in the case of considering radiological patterns of pneumonia. Early diagnosis and treatment often greatly improve prognosis. We herein reported a case of 40-year-old patient who underwent chest CT scan with the discovery of ground-glass opacity, intralobular reticular opacity and interlobular septal thickening, consolidation, and air bronchogram sign, which were mainly located in the middle and upper lobes of the right lung. It was considered to be infection related pneumonia based on the negative reverse transcription-PCR (RT-PCR) result of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The next-generation sequencing (NGS) of bronchoalveolar lavage fluid (BALF) was performed and detected nucleic acid sequences of Klebsiella sp. Consequently, the patient accepted sensitive intravenous antibiotics therapy for 13 days and had a remarkable clinical and radiological improvement. His case was followed up through imaging procedures. Because of possible radiologic and clinical similarities between aspiration and COVID-19 pneumonia, COVID-19 can be of some value in proposing a differential diagnosis of aspiration pneumonia. Clinicians could suggest a correct diagnosis by careful examination of the CT images together with attention to the clinical history and judicious utilization of NGS, especially.
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Affiliation(s)
- Quan Zhang
- Pulmonary and Critical Care Medicine, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Wei Xu
- Department of Neurology, The First People's Hospital of Chenzhou, Chenzhou, China
| | - Fei Peng
- Pulmonary and Critical Care Medicine, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Si Lei
- Pulmonary and Critical Care Medicine, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Yanjun Zhong
- Critical Care Medicine, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Jun Yi
- Department of Gastroenterology, Xiangya Hospital of Central South University, Changsha, China
| | - Shangjie Wu
- Pulmonary and Critical Care Medicine, The Second Xiangya Hospital, Central South University, Changsha, China
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Kosutova P, Mikolka P. Aspiration syndromes and associated lung injury: incidence, pathophysiology and management. Physiol Res 2021. [DOI: 10.33549//physiolres.934767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Aspiration is a common condition affecting healthy or sick patients which could create an acute or chronic inflammatory reaction in the lungs. Aspiration syndromes could be categorized according to a content entering the respiratory system into bacterial aspiration pneumonia with the gastric or oropharyngeal bacteria entering, aspiration chemical pneumonitis with bacteria-freegastric acid aspiration, or aspiration of a foreign body which causes an acute pulmonary emergency. There are differences in the clinical presentation of volume-dependent aspirations (microaspiration and macroaspiration): the higher is the volume of aspiration, the greater is the injury to the patient and more serious are the health consequences (with 70 % mortality rate for hospitalized patients). Aspiration syndromes can affect both the airways and pulmonary parenchyma, leading to acute lung injury, increased hospitalization rate and worse outcomes in critically ill patients. Impaired alveolar-capillary permeability, oedema formation, neutrophilic inflammatory response and pulmonary surfactant inactivation lead to reduced lung compliance and loss of aerated lung tissue and give rise to hypoxemia and respiratory failure. This review discusses the effect of aspiration events on the pulmonary tissue. The main focus is to distinguish the differences between bacterial and chemical pneumonia, their clinical presentation and symptoms, risk factors of developing the changes, possibilities of diagnostics and management as well as prevention of aspirations. Because of a risk of serious lung damage after the aspiration, pathophysiology and processes leading to lung tissue injury are discussed in detail. Data sources represent a systematic literature search using relevant medical subject headings.
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Okabe T, Kamiya Y, Kikuchi T, Goto H, Umemura M, Suzuki Y, Sugita Y, Naiki Y, Hasegawa Y, Hayashi JI, Kawamura S, Sawada N, Takayanagi Y, Fujimura T, Higuchi N, Mitani A. Porphyromonas gingivalis Components/Secretions Synergistically Enhance Pneumonia Caused by Streptococcus pneumoniae in Mice. Int J Mol Sci 2021; 22:ijms222312704. [PMID: 34884507 PMCID: PMC8657795 DOI: 10.3390/ijms222312704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 11/19/2021] [Accepted: 11/22/2021] [Indexed: 11/16/2022] Open
Abstract
Streptococcus pneumoniae is an important causative organism of respiratory tract infections. Although periodontal bacteria have been shown to influence respiratory infections such as aspiration pneumonia, the synergistic effect of S. pneumoniae and Porphyromonas gingivalis, a periodontopathic bacterium, on pneumococcal infections is unclear. To investigate whether P. gingivalis accelerates pneumococcal infections, we tested the effects of inoculating P. gingivalis culture supernatant (PgSup) into S. pneumoniae-infected mice. Mice were intratracheally injected with S. pneumoniae and PgSup to induce pneumonia, and lung histopathological sections and the absolute number and frequency of neutrophils and macrophages in the lung were analyzed. Proinflammatory cytokine/chemokine expression was examined by qPCR and ELISA. Inflammatory cell infiltration was observed in S. pneumoniae-infected mice and S. pnemoniae and PgSup mixed-infected mice, and mixed-infected mice showed more pronounced inflammation in lung. The ratios of monocytes/macrophages and neutrophils were not significantly different between the lungs of S. pneumoniae-infected mice and those of mixed-infected mice. PgSup synergistically increased TNF-α expression/production and IL-17 production compared with S. pneumoniae infection alone. We demonstrated that PgSup enhanced inflammation in pneumonia caused by S. pneumoniae, suggesting that virulence factors produced by P. gingivalis are involved in the exacerbation of respiratory tract infections such as aspiration pneumonia.
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Affiliation(s)
- Teppei Okabe
- Department of Periodontology, School of Dentistry, Aichi Gakuin University, 2-11 Suemori-dori, Chikusa-ku, Nagoya 464-8651, Japan; (T.O.); (T.K.); (H.G.); (Y.S.); (J.H.); (S.K.); (N.S.); (Y.T.); (T.F.); (A.M.)
| | - Yosuke Kamiya
- Department of Periodontology, School of Dentistry, Aichi Gakuin University, 2-11 Suemori-dori, Chikusa-ku, Nagoya 464-8651, Japan; (T.O.); (T.K.); (H.G.); (Y.S.); (J.H.); (S.K.); (N.S.); (Y.T.); (T.F.); (A.M.)
- Correspondence: ; Tel.: +81-52-759-2150
| | - Takeshi Kikuchi
- Department of Periodontology, School of Dentistry, Aichi Gakuin University, 2-11 Suemori-dori, Chikusa-ku, Nagoya 464-8651, Japan; (T.O.); (T.K.); (H.G.); (Y.S.); (J.H.); (S.K.); (N.S.); (Y.T.); (T.F.); (A.M.)
| | - Hisashi Goto
- Department of Periodontology, School of Dentistry, Aichi Gakuin University, 2-11 Suemori-dori, Chikusa-ku, Nagoya 464-8651, Japan; (T.O.); (T.K.); (H.G.); (Y.S.); (J.H.); (S.K.); (N.S.); (Y.T.); (T.F.); (A.M.)
| | - Masayuki Umemura
- Molecular Microbiology Group, Department of Tropical Infectious Diseases, Tropical Biosphere Research Center, University of the Ryukyus, 1 Senbaru, Nishihara-cho, Nakagami-gun, Nishihara 903-0213, Japan;
| | - Yuki Suzuki
- Department of Periodontology, School of Dentistry, Aichi Gakuin University, 2-11 Suemori-dori, Chikusa-ku, Nagoya 464-8651, Japan; (T.O.); (T.K.); (H.G.); (Y.S.); (J.H.); (S.K.); (N.S.); (Y.T.); (T.F.); (A.M.)
| | - Yoshihiko Sugita
- Department of Oral Pathology and Forensic Odontology, School of Dentistry, Aichi Gakuin University, 1-100 Kusumoto-cho, Chikusa-ku, Nagoya 464-8650, Japan;
| | - Yoshikazu Naiki
- Department of Microbiology, School of Dentistry, Aichi Gakuin University, 1-100 Kusumoto-cho, Chikusa-ku, Nagoya 464-8650, Japan; (Y.N.); (Y.H.)
| | - Yoshiaki Hasegawa
- Department of Microbiology, School of Dentistry, Aichi Gakuin University, 1-100 Kusumoto-cho, Chikusa-ku, Nagoya 464-8650, Japan; (Y.N.); (Y.H.)
| | - Jun-ichiro Hayashi
- Department of Periodontology, School of Dentistry, Aichi Gakuin University, 2-11 Suemori-dori, Chikusa-ku, Nagoya 464-8651, Japan; (T.O.); (T.K.); (H.G.); (Y.S.); (J.H.); (S.K.); (N.S.); (Y.T.); (T.F.); (A.M.)
| | - Shotaro Kawamura
- Department of Periodontology, School of Dentistry, Aichi Gakuin University, 2-11 Suemori-dori, Chikusa-ku, Nagoya 464-8651, Japan; (T.O.); (T.K.); (H.G.); (Y.S.); (J.H.); (S.K.); (N.S.); (Y.T.); (T.F.); (A.M.)
| | - Noritaka Sawada
- Department of Periodontology, School of Dentistry, Aichi Gakuin University, 2-11 Suemori-dori, Chikusa-ku, Nagoya 464-8651, Japan; (T.O.); (T.K.); (H.G.); (Y.S.); (J.H.); (S.K.); (N.S.); (Y.T.); (T.F.); (A.M.)
| | - Yuhei Takayanagi
- Department of Periodontology, School of Dentistry, Aichi Gakuin University, 2-11 Suemori-dori, Chikusa-ku, Nagoya 464-8651, Japan; (T.O.); (T.K.); (H.G.); (Y.S.); (J.H.); (S.K.); (N.S.); (Y.T.); (T.F.); (A.M.)
| | - Takeki Fujimura
- Department of Periodontology, School of Dentistry, Aichi Gakuin University, 2-11 Suemori-dori, Chikusa-ku, Nagoya 464-8651, Japan; (T.O.); (T.K.); (H.G.); (Y.S.); (J.H.); (S.K.); (N.S.); (Y.T.); (T.F.); (A.M.)
| | - Naoya Higuchi
- Department of Endodontics, School of Dentistry, Aichi Gakuin University, 2-11 Suemori-dori, Chikusa-ku, Nagoya 464-8651, Japan;
| | - Akio Mitani
- Department of Periodontology, School of Dentistry, Aichi Gakuin University, 2-11 Suemori-dori, Chikusa-ku, Nagoya 464-8651, Japan; (T.O.); (T.K.); (H.G.); (Y.S.); (J.H.); (S.K.); (N.S.); (Y.T.); (T.F.); (A.M.)
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Cui Y, Cui Y. [Intraoperative Aspiration]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2021; 23:393-401. [PMID: 32429641 PMCID: PMC7260386 DOI: 10.3779/j.issn.1009-3419.2020.101.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
术中误吸是外科手术中常见的肺部并发症,麻醉和体位是导致术中误吸的主要因素。近年来,围手术期肺保护已受到外科和麻醉医师的广泛关注,如何加速术后康复进程,减少相关并发症发生,显著改善患者预后已成为当前外科治疗的主要目标。本文将以术中误吸为重点,从解剖、病理生理、表现、诊断、处理和预防等方面展开综述。
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Affiliation(s)
- Yiyao Cui
- Department of Thoracic Surgery, Beijing Friendship Hospital Affiliated to Capital Medical University, Beijing 100050, China
| | - Yong Cui
- Department of Thoracic Surgery, Beijing Friendship Hospital Affiliated to Capital Medical University, Beijing 100050, China
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Vedamurthy A, Rajendran I, Manian F. Things We Do for No Reason™: Routine Coverage of Anaerobes in Aspiration Pneumonia. J Hosp Med 2020; 15:754-756. [PMID: 32966204 DOI: 10.12788/jhm.3506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 03/25/2020] [Indexed: 11/20/2022]
Affiliation(s)
- Amar Vedamurthy
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Iniya Rajendran
- Department of Medicine, Boston Medical Center, Boston, Massachusetts
| | - Farrin Manian
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
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Hamao N, Ito I, Konishi S, Tanabe N, Shirata M, Oi I, Tsukino M, Matsumoto H, Yasutomo Y, Kadowaki S, Hirai T. Comparison of ceftriaxone plus macrolide and ampicillin/sulbactam plus macrolide in treatment for patients with community-acquired pneumonia without risk factors for aspiration: an open-label, quasi-randomized, controlled trial. BMC Pulm Med 2020; 20:160. [PMID: 32503515 PMCID: PMC7275365 DOI: 10.1186/s12890-020-01198-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 05/22/2020] [Indexed: 02/08/2023] Open
Abstract
Background Ceftriaxone (CTRX) and ampicillin/sulbactam (ABPC/SBT) are recommended by various guidelines as the first-line antibiotics for community-acquired pneumonia (CAP). However, which of these antibiotics is more effective for treating non-aspiration CAP remains unclear. Methods This study was a prospective, single-center, open-label, quasi-randomized controlled trial. Patients with adult CAP without risk for aspiration were allocated to either a CTRX or ABPC/SBT group based on the date of hospital admission. Macrolide was added to patients in each group. The primary outcome was the clinical response in the validated per-protocol (VPP) population at end of treatment (EOT). The secondary outcomes were clinical response during treatment and at end of study (EOS) in the VPP population, and mortality rate at day 30 in the modified intention-to-treat (MITT) population. Results Of 696 screened patients, 433 patients were excluded and 263 patients were allocated to receive either of the treatments. Males comprised 54% of patients and mean age and PSI were 62.1 ± 19.8 years and 69.3 ± 30.0, respectively, with 124 patients allocated to the CTRX group and 138 patients allocated to the ABPC/SBT group. The clinical effectiveness rate for the VPP population at EOT was 90% in the CTRX and 96% in the ABPC/SBT group (p = 0.072, 95% confidence interval [CI] of risk difference [RD]: − 12.6–0.8%). No significant difference in effectiveness at day 4 was observed between the CTRX and ABPC/SBT groups (p = 0.079, 95%CI of RD: − 12.1–0.4%), but at day 7, ABPC/SBT was significantly more effective than CTRX in the VPP population (p = 0.047, 95%CI of RD: − 13.3–-0.4%). No significant difference in late response at EOS was seen between CTRX and ABPC/SBT groups: cure (89 [86%] and 102 [94%]), relapse (5 [5%] and 1 [1%]) and failure (10 [10%] and 5 [5%]; p = 0.053). Deaths within 30 days in MITT population was higher in CTRX group (4 [3%]) than in ABPC/SBT group (0 [0%]) (p = 0.048, 95%CI of RD: 0.1–6.3%). Conclusion No significant difference in effectiveness was found between ABPC/SBT and CTRX at EOT. However, ABPC/SBT might be more effective in the early phase of treatment. Trial registration UMIN-CTR, UMIN000037464. Registered 25 July 2019 – Retrospectively registered, https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000042262
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Affiliation(s)
- Nobuyoshi Hamao
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin-kawaracho, Sakyo, Kyoto, 606-8507, Japan
| | - Isao Ito
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin-kawaracho, Sakyo, Kyoto, 606-8507, Japan. .,Department of Internal Medicine, Ono Municipal Hospital, 323 Naka-cho, Ono, Hyogo, 675-1332, Japan.
| | - Satoshi Konishi
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin-kawaracho, Sakyo, Kyoto, 606-8507, Japan.,Department of Internal Medicine, Ono Municipal Hospital, 323 Naka-cho, Ono, Hyogo, 675-1332, Japan
| | - Naoya Tanabe
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin-kawaracho, Sakyo, Kyoto, 606-8507, Japan.,Department of Internal Medicine, Ono Municipal Hospital, 323 Naka-cho, Ono, Hyogo, 675-1332, Japan
| | - Masahiro Shirata
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin-kawaracho, Sakyo, Kyoto, 606-8507, Japan
| | - Issei Oi
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin-kawaracho, Sakyo, Kyoto, 606-8507, Japan
| | - Mitsuhiro Tsukino
- Department of Internal Medicine, Ono Municipal Hospital, 323 Naka-cho, Ono, Hyogo, 675-1332, Japan.,Department of Respiratory Medicine, Hikone Municipal Hospital, 1882 Hassakacho, Hikone, Shiga, 522-8539, Japan
| | - Hisako Matsumoto
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin-kawaracho, Sakyo, Kyoto, 606-8507, Japan
| | - Yoshiro Yasutomo
- Department of Internal Medicine, Ono Municipal Hospital, 323 Naka-cho, Ono, Hyogo, 675-1332, Japan
| | - Seizo Kadowaki
- Department of Internal Medicine, Ono Municipal Hospital, 323 Naka-cho, Ono, Hyogo, 675-1332, Japan
| | - Toyohiro Hirai
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin-kawaracho, Sakyo, Kyoto, 606-8507, Japan
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Aspiration pneumonia and pneumonitis: a spectrum of infectious/noninfectious diseases affecting the lung. Curr Opin Infect Dis 2020; 32:152-157. [PMID: 30676341 DOI: 10.1097/qco.0000000000000524] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
PURPOSE OF REVIEW Our purpose is to describe aspiration pneumonia/pneumonitis as a spectrum of infectious/noninfectious diseases affecting the lung. We summarize diagnosis, risk factors, treatment, and strategies for prevention of aspiration. RECENT FINDINGS Aspiration is present in normal individuals, and disease manifestation depends on the chemical characteristics, frequency, and volume of inoculum. Anaerobes, though present, are no longer the predominant microbes isolated in aspiration pneumonia. Targets for preventing aspiration including improved oral hygiene and positional feeding have had mixed results. Patients diagnosed by clinicians with aspiration pneumonia experience greater morbidity and mortality than patients with community-acquired pneumonia. SUMMARY Aspiration pneumonia and pneumonitis are part of the pneumonia continuum and share similarities in pathophysiology, microbiology, and treatment. Modern microbiology demonstrates that the lung is not sterile, and isolates in aspiration pneumonia frequently include aerobes or mixed cultures. Treatment for aspiration pneumonia should include antibiotic coverage for oral anaerobes, aerobes associated with community-acquired pneumonia, and resistant organisms depending on appropriate clinical context. Additional studies targeting prevention of aspiration and investigating the increased morbidity and mortality associated with aspiration pneumonia are warranted.
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13
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Adachi K, Umezaki T, Matsubara N, Lee Y, Inoguchi T, Kikuchi Y. Tracheoesophageal diversion improves oral uptake of food: a retrospective study. Eur Arch Otorhinolaryngol 2020; 277:2293-2298. [DOI: 10.1007/s00405-020-05988-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 04/15/2020] [Indexed: 11/24/2022]
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14
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Hasegawa S, Shiraishi A, Yaegashi M, Hosokawa N, Morimoto K, Mori T. Ceftriaxone versus ampicillin/sulbactam for the treatment of aspiration-associated pneumonia in adults. J Comp Eff Res 2019; 8:1275-1284. [DOI: 10.2217/cer-2019-0041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To compare hospital mortality in patients with aspiration-associated pneumonia treated with ceftriaxone (CTRX) and in those treated with ampicillin/sulbactam (ABPC/SBT). Methods: From a Japanese multicentre observational study cohort of patients with pneumonia, those diagnosed with pneumonia and having at least one aspiration-related risk factor were selected. Propensity score-matching analysis was used to balance baseline characteristics of the participants and compare hospital mortality of patients treated with CTRX and those treated with ABPC/SBT. Results: Hospital mortality did not significantly differ between patients treated with CTRX and those treated with ABPC/SBT (6.6 vs 10.7%, risk difference -4.0, 95% CI [-9.4, 1.3]; p = 0.143). Conclusion: Further studies are needed to compare CTRX and ABPC/SBT treatments in patients with aspiration-associated pneumonia.
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Affiliation(s)
- Shinya Hasegawa
- Department of Infectious Disease, Tokyo Metro Tama Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo 183-8524, Japan
| | - Atsushi Shiraishi
- Emergency & Trauma Center, Kameda Medical Center, 929 Higashi-cho, Kamogawa, Chiba 296-8602, Japan
| | - Makito Yaegashi
- Department of General Internal Medicine, Kameda Medical Center, 929 Higashi-cho, Kamogawa, Chiba 296-8602, Japan
| | - Naoto Hosokawa
- Department of Infectious Disease, Kameda Medical Center, 929 Higashi-cho, Kamogawa, Chiba 296-8602, Japan
| | - Konosuke Morimoto
- Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University, 1-14 Bunkyo-cho, Nagasaki 852-8521, Japan
| | - Takahiro Mori
- Department of General Internal Medicine, Eastern Chiba Medical Center, 3-6-2 Okayamadai, Togane, Chiba 283-8686, Japan
- Department of General Medical Science, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan
- Research & Development Center for Health Services, Faculty of Medicine, University of Tsukuba, 1-1-1 Tenno-dai, Tsukuba, Ibaraki 305-8575, Japan
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15
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Rodriguez AE, Restrepo MI. New perspectives in aspiration community acquired Pneumonia. Expert Rev Clin Pharmacol 2019; 12:991-1002. [PMID: 31516051 DOI: 10.1080/17512433.2019.1663730] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Introduction: Aspiration pneumonia is a subclass of community-acquired pneumonia that is expected to have an increasing contribution in mortality and morbidity, particularly in the elderly population over the next coming decades. While studies have revealed significant progress in identifying risk factors for aspiration pneumonia, the clinical presentation and diagnosis remain challenging to healthcare providers. Areas covered: We conducted a broad literature review using the MeSH heading in PubMed/MEDLINE of 'aspiration pneumonia' from January 1970 to July 2019. The understanding of the microbiology of aspiration pneumonia has evolved from a possible shift in the causative organisms away from anaerobes to traditional community-acquired pneumonia organisms. The importance of this shift is not yet known, but it has questioned the pathogenic role of anaerobes, appropriate anaerobic testing and the role of these pathogens in the pulmonary microbiome in patients with pneumonia. The identification of risk factors led to strategies to prevent or minimize the risk of aspiration pneumonia with moderate success. Expert opinion: Our expert opinion is that further research is needed to determine the role of the microbiome with aspiration pneumonia and patient risk factors. There is also a great need to develop clinical tools to help providers diagnose, treat, and prevent aspiration pneumonia.
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Affiliation(s)
- Abraham E Rodriguez
- Division of Pulmonary Diseases & Critical Care Medicine, University of Texas Health , San Antonio , TX , USA.,Division of Pulmonary Diseases & Critical Care Medicine, South Texas Veterans Health Care System , San Antonio , TX , USA
| | - Marcos I Restrepo
- Division of Pulmonary Diseases & Critical Care Medicine, University of Texas Health , San Antonio , TX , USA.,Division of Pulmonary Diseases & Critical Care Medicine, South Texas Veterans Health Care System , San Antonio , TX , USA
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16
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Lopes MP, Cruz ÁA, Xavier MT, Stöcker A, Carvalho-Filho P, Miranda PM, Meyer RJ, Soledade KR, Gomes-Filho IS, Trindade SC. Prevotella intermedia and periodontitis are associated with severe asthma. J Periodontol 2019; 91:46-54. [PMID: 31342509 DOI: 10.1002/jper.19-0065] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 05/24/2019] [Accepted: 05/27/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Periodontitis, an inflammatory disease of multibacterial etiology that affects the protective and supporting tissues surrounding teeth, can influence the course of respiratory diseases, such as asthma, due to epithelial alterations arising from inflammatory and immunological processes, bronchial remodeling, or by the aspiration of pathogenic colonizers found in periodontal pockets. This study evaluated the levels of periodontal pathogens Prevotella intermedia, Porphyromonas gingivalis, Treponema denticola, Tannerella forsythia, and Aggregatibacter actinomycetemcomitans in the subgingival biofilm of individuals with and without severe asthma. METHODS A case-control study enrolling 457 individuals (220 with asthma and 237 without asthma) was conducted at the Program for Control of Asthma in Bahia (ProAR) Clinic located in Salvador, Bahia, Brazil. A structured questionnaire was used to obtain data on sociodemographic, health status, and lifestyle habits. A clinical periodontal assessment was performed, including bleeding on probing, probing depth, and clinical attachment level. Subgingival biofilm was collected at the deepest site of each sextant, and bacterial DNA was extracted. Quantitative real-time PCR analysis was performed to detect and relatively quantify periodontopathogens in the biofilm. RESULTS Statistically significant positive associations were found between periodontitis and severe asthma, (odds ratio [OR]adjusted] : 4.00; 95% confidence interval [CI]: 2.26 to 7.10). High levels of P. intermedia were found in association with the presence of severe asthma (ORadjusted : 2.64; 95% CI: 1.62 to 4.39; P < 0.01). CONCLUSIONS The present results suggest that periodontitis and P. intermedia are associated with severe asthma. However, the functional consequences of this dysbiosis upon asthma susceptibility and its phenotypes remain unclear.
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Affiliation(s)
- Mabel P Lopes
- Post-Graduation Program, Federal University of Bahia, Salvador, Brazil
| | - Álvaro A Cruz
- Faculty of Medicine, Federal University of Bahia, Salvador, Brazil
| | - Márcia T Xavier
- Department of Biointeraction, Federal University of Bahia, Salvador, Brazil
| | - Andreas Stöcker
- Universitary Hospital Professor Edgard Santos, Federal University of Bahia, Salvador, Brazil
| | | | | | - Roberto J Meyer
- Department of Biointeraction, Federal University of Bahia, Salvador, Brazil
| | - Kaliane R Soledade
- Department of Biointeraction, Federal University of Bahia, Salvador, Brazil
| | - Isaac S Gomes-Filho
- Department of Health, Feira de Santana State University, Feira de Santana, Brazil
| | - Soraya C Trindade
- Post-Graduation Program, Federal University of Bahia, Salvador, Brazil.,Department of Health, Feira de Santana State University, Feira de Santana, Brazil
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17
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Kato H, Hagihara M, Yokoyama Y, Suematsu H, Asai N, Koizumi Y, Yamagishi Y, Mikamo H. Comparison of the in Vivo Activities of Garenoxacin and Levofloxacin in a Murine Model of Pneumonia by Mixed-Infection with Streptococcus pneumoniae and Parvimonas micra. Jpn J Infect Dis 2019; 72:407-412. [PMID: 31366860 DOI: 10.7883/yoken.jjid.2019.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Community-acquired pneumonia (CAP) can involve mixed-species bacterial infection. However, few studies have investigated antimicrobial efficacy in the treatment of mixed species infections. This study aimed to compare the in vivo antimicrobial activity of garenoxacin (GRNX) and levofloxacin (LVFX) against Streptococcus pneumoniae and Parvimonas micra in a murine model of mixed species bacterial pneumonia. S. pneumoniae D-6888 and P. micra No. 242 were used in this study. Antimicrobial activity toward each isolate was calculated as the change in bacterial count in the lungs (Δlog10 CFU/mL) of mice after 24 h of treatment compared with the count in pretreated animals (0 h). The MICs of GRNX and LVFX against S. pneumoniae D-6888 were 0.06 and 0.5 mg/L and the MICs against P. micra No. 242 were 0.03 and 0.12 mg/L, respectively. In a murine pneumonia mixed-infection model, GRNX showed significantly higher in vivo antimicrobial activity against S. pneumoniae than LVFX (GRNX; -2.02 ± 0.99 log10 CFU/mL vs. LVFX; -0.97 ± 0.61 log10 CFU/mL, p = 0.0188). GRNX displayed about 2-fold more potent activity against P. micra than LVFX (GRNX; -1.12 ± 0.56 log10 CFU/mL vs. LVFX; -0.61 ± 0.43 log10 CFU/mL, p = 0.1029). These results suggest that GRNX is preferable for the treatment of mixed species bacterial CAP.
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Affiliation(s)
- Hideo Kato
- Department of Clinical Infectious Diseases, Aichi Medical University
| | - Mao Hagihara
- Department of Clinical Infectious Diseases, Aichi Medical University.,Department of Molecular Epidemiology and Biomedical Sciences, Aichi Medical University
| | - Yuki Yokoyama
- Department of Clinical Infectious Diseases, Aichi Medical University
| | - Hiroyuki Suematsu
- Department of Clinical Infectious Diseases, Aichi Medical University
| | - Nobuhiro Asai
- Department of Clinical Infectious Diseases, Aichi Medical University
| | - Yusuke Koizumi
- Department of Clinical Infectious Diseases, Aichi Medical University
| | - Yuka Yamagishi
- Department of Clinical Infectious Diseases, Aichi Medical University
| | - Hiroshige Mikamo
- Department of Clinical Infectious Diseases, Aichi Medical University
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18
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Yoon HY, Shim SS, Kim SJ, Lee JH, Chang JH, Lee SH, Ryu YJ. Long-Term Mortality and Prognostic Factors in Aspiration Pneumonia. J Am Med Dir Assoc 2019; 20:1098-1104.e4. [PMID: 31080159 DOI: 10.1016/j.jamda.2019.03.029] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 03/19/2019] [Accepted: 03/25/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Aspiration pneumonia is a leading cause of death among older patients; however, little is known about the long-term mortality in aspiration pneumonia. The purpose of this study was to evaluate long-term mortality and its associated factors in patients with aspiration pneumonia. DESIGN Retrospective cohort study. SETTING AND PARTICIPANTS In total, 550 patients with aspiration pneumonia (median age: 78.0 years, 66.4% male) with compatible clinical symptoms and chest computed tomography images were enrolled at a single tertiary center from 2006 to 2016. MEASURES The 1-, 3-, and 5-year mortality rates were evaluated for all patients. The prognostic factors for 1-year and 5-year mortality were also evaluated using Cox proportional hazard models. RESULTS A total of 441 (80.2%) patients died during a median follow-up of 50.7 weeks. The 1-, 3-, and 5-year mortality rates were 49.0%, 67.1%, and 76.9%, respectively. Multivariate analysis identified 5 risk factors for 1-year mortality of male sex [hazard ratio (HR) 1.533, P = .003], low body mass index (HR 0.934, P = .002), hypoalbuminemia, anemia (0.973, P = .032), and mechanical ventilation (HR 2.052, P < .001), which were also independent prognostic factors for 5-year mortality. During the follow-up period, 133 (24.2%) patients experienced recurrent aspiration pneumonia. However, Kaplan-Meier analysis showed no significant differences in survival curves between patients with single and recurrent aspiration pneumonia (P = .371). CONCLUSIONS/IMPLICATIONS Long-term prognosis of aspiration pneumonia was poor as a result of underlying morbidity instead of the aspiration pneumonia itself. Our findings suggest that prognostic indices for patients with aspiration pneumonia including the patient's underlying conditions should be devised.
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Affiliation(s)
- Hee-Young Yoon
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Sung Shine Shim
- Department of Radiology, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Soo Jung Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Jin Hwa Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Jung Hyun Chang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Su Hwan Lee
- Division of Pulmonology, Department of Internal Medicine, Institute of Chest Diseases, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
| | - Yon Ju Ryu
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Republic of Korea.
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19
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Jeon I, Jung GP, Seo HG, Ryu JS, Han TR, Oh BM. Proportion of Aspiration Pneumonia Cases Among Patients With Community-Acquired Pneumonia: A Single-Center Study in Korea. Ann Rehabil Med 2019; 43:121-128. [PMID: 31072078 PMCID: PMC6509581 DOI: 10.5535/arm.2019.43.2.121] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 10/10/2018] [Indexed: 12/13/2022] Open
Abstract
Objective To investigate the proportion of aspiration pneumonia cases among patients with community-acquired pneumonia in Korea. Methods This retrospective study included patients with community-acquired pneumonia who had been admitted to the emergency department of a university-affiliated tertiary hospital in Gyeonggi Province, Korea between January 1, 2016 and December 31, 2016. Among these patients, those with aspiration pneumonia were identified using ICD-10 codes (J69.*). Patients with recurrent pneumonia were excluded, as were those who were immunocompromised. The proportion of cases of aspiration pneumonia was calculated, and the characteristics and clinical outcomes of patients with aspiration pneumonia and non-aspiration pneumonia were compared. Results The proportion of aspiration pneumonia cases among patients with community-acquired pneumonia was 14.2%. Patients with aspiration pneumonia were significantly more likely to be older (p<0.001) and male (p<0.001), and to have a higher confusion, uremia, respiratory rate, blood pressure, and age ≥65 years (CURB-65) score (p<0.001) as compared to patients with non-aspiration pneumonia. They were also more likely to require admission to the intensive care unit (p<0.001) and a longer hospital stay (p<0.001). Conclusion Aspiration pneumonia accounts for 14.2% of all cases of community-acquired pneumonia in Korea. These data may contribute to the establishment of healthcare strategies for managing aspiration pneumonia among Korean adults.
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Affiliation(s)
- Inpyo Jeon
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Gwang Pyo Jung
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Han Gil Seo
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Korea
| | - Ju Seok Ryu
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Korea.,Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Tai Ryoon Han
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Byung-Mo Oh
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Korea.,Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Korea
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20
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Nie L, Zhou C, Wu H, Zhou Q, Meng F. Primary Pulmonary Acinic Cell Carcinoma: A Clinicopathological Study of 6 Cases and Literature Review. Int J Surg Pathol 2019; 27:584-592. [PMID: 30898020 DOI: 10.1177/1066896919836499] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Primary pulmonary acinic cell carcinoma (ACC) is rare. The clinicopathological features are not identical to that of classic ACC that leads to misdiagnosis. In this article, we summarized the clinicopathological features of 25 such cases, including 6 cases in this series and additional 19 cases in the literature. Pulmonary ACCs showed an overwhelming solid growth pattern. The neoplastic cells had eosinophilic granular and clear cytoplasm in most cases and displayed basophilic cytoplasm in only 4 cases. Intratumoral fibrous septa, mitotic figure, necrosis, and psammoma bodies were observed in some cases. Prominent nuclear atypia and perineural invasion might suggest high-grade transformation, metastasis, and recurrence. The tumor cells were strongly positive for CK8/18 and negative for TTF-1, p63, S-100, mammaglobin, MUC5b, MUC5ac, and DOG1. CK7 was exclusively positive for neoplastic cells with ductal differentiation. Of the 25 included cases, 10 cases were initially misdiagnosed. The tumor was prone to involve the right bronchus. The patient outcome was favorable. The accurate diagnosis of primary pulmonary ACC relies on comprehensive evaluation of histological and immunohistochemical features and realization of the difference from classic ACC.
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Affiliation(s)
- Ling Nie
- The Affiliated Drum Tower Hospital, Nanjing University, Nanjing, Jiangsu Province, China
| | - Chunlei Zhou
- Children’s Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Hongyan Wu
- The Affiliated Drum Tower Hospital, Nanjing University, Nanjing, Jiangsu Province, China
| | - Qiang Zhou
- The Affiliated Drum Tower Hospital, Nanjing University, Nanjing, Jiangsu Province, China
| | - Fanqing Meng
- The Affiliated Drum Tower Hospital, Nanjing University, Nanjing, Jiangsu Province, China
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21
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Fidler MM, Reulen RC, Bright CJ, Henson KE, Kelly JS, Jenney M, Ng A, Whelan J, Winter DL, Frobisher C, Hawkins MM. Respiratory mortality of childhood, adolescent and young adult cancer survivors. Thorax 2018; 73:959-968. [PMID: 29748251 PMCID: PMC6166601 DOI: 10.1136/thoraxjnl-2017-210683] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 02/20/2018] [Accepted: 03/12/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Exposure to radiation and/or chemotherapy during cancer treatment can compromise respiratory function. We investigated the risk of long-term respiratory mortality among 5-year cancer survivors diagnosed before age 40 years using the British Childhood Cancer Survivor Study (BCCSS) and Teenage and Young Adult Cancer Survivor Study (TYACSS). METHODS The BCCSS comprises 34 489 cancer survivors diagnosed before 15 years from 1940 to 2006 in Great Britain. The TYACSS includes 200 945 cancer survivors diagnosed between 15 years and 39 years from 1971 to 2006 in England and Wales. Standardised mortality ratios and absolute excess risks were used. FINDINGS Overall, 164 and 1079 respiratory deaths were observed in the BCCSS and TYACSS cohorts respectively, which was 6.8 (95% CI 5.8 to 7.9) and 1.7 (95% CI 1.6 to 1.8) times that expected, but the risks varied substantially by type of respiratory death. Greatest excess numbers of deaths were experienced after central nervous system (CNS) tumours in the BCCSS and after lung cancer, leukaemia, head and neck cancer and CNS tumours in the TYACSS. The excess number of respiratory deaths increased with increasing attained age, with seven (95% CI 2.4 to 11.3) excess deaths observed among those aged 50+ years in the BCCSS and three (95% CI 1.4 to 4.2) excess deaths observed among those aged 60+ years in the TYACSS. It was reassuring to see a decline in the excess number of respiratory deaths among those diagnosed more recently in both cohorts. CONCLUSIONS Prior to this study, there was almost nothing known about the risks of respiratory death after cancer diagnosed in young adulthood, and this study addresses this gap. These new findings will be useful for both survivors and those involved in their clinical management and follow-up.
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Affiliation(s)
- Miranda M Fidler
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | - Raoul C Reulen
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Chloe J Bright
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Katherine E Henson
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Clinical Trial Service Unite, University of Oxford, Oxford, UK
| | - Julie S Kelly
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Meriel Jenney
- Department of Paediatric Oncology, Children's Hospital for Wales, Cardiff, UK
| | - Antony Ng
- Department of Paediatric Oncology, Bristol Royal Hospital for Children, Bristol, UK
| | - Jeremy Whelan
- Department of Oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | - David L Winter
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Clare Frobisher
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Michael M Hawkins
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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22
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Pulmonary aspiration only increases the risk of right-sided pneumonia in children. Nucl Med Commun 2018; 39:505-510. [DOI: 10.1097/mnm.0000000000000836] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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23
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Brodsky MB, De I, Chilukuri K, Huang M, Palmer JB, Needham DM. Coordination of Pharyngeal and Laryngeal Swallowing Events During Single Liquid Swallows After Oral Endotracheal Intubation for Patients with Acute Respiratory Distress Syndrome. Dysphagia 2018; 33:768-777. [PMID: 29713897 DOI: 10.1007/s00455-018-9901-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 04/19/2018] [Indexed: 12/28/2022]
Abstract
To evaluate timing and duration differences in airway protection and esophageal opening after oral intubation and mechanical ventilation for acute respiratory distress syndrome (ARDS) survivors versus age-matched healthy volunteers. Orally intubated adult (≥ 18 years old) patients receiving mechanical ventilation for ARDS were evaluated for swallowing impairments via a videofluoroscopic swallow study (VFSS) during usual care. Exclusion criteria were tracheostomy, neurological impairment, and head and neck cancer. Previously recruited healthy volunteers (n = 56) served as age-matched controls. All subjects were evaluated using 5-ml thin liquid barium boluses. VFSS recordings were reviewed frame-by-frame for the onsets of 9 pharyngeal and laryngeal events during swallowing. Eleven patients met inclusion criteria, with a median (interquartile range [IQR]) intubation duration of 14 (9, 16) days, and VFSSs completed a median of 5 (4, 13) days post-extubation. After arrival of the bolus in the pharynx, ARDS patients achieved maximum laryngeal closure a median (IQR) of 184 (158, 351) ms later than age-matched, healthy volunteers (p < 0.001) and it took longer to achieve laryngeal closure with a median (IQR) difference of 151 (103, 217) ms (p < 0.001), although there was no significant difference in duration of laryngeal closure. Pharyngoesophageal segment opening was a median (IQR) of - 116 (- 183, 1) ms (p = 0.004) shorter than in age-matched, healthy controls. Evaluation of swallowing physiology after oral endotracheal intubation in ARDS patients demonstrates slowed pharyngeal and laryngeal swallowing timing, suggesting swallow-related muscle weakness. These findings may highlight specific areas for further evaluation and potential therapeutic intervention to reduce post-extubation aspiration.
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Affiliation(s)
- Martin B Brodsky
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, 600 N. Wolfe St. - Phipps 181, Baltimore, MD, 21287, USA. .,Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University, Baltimore, MD, USA.
| | - Ishani De
- Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University, Baltimore, MD, USA
| | - Kalyan Chilukuri
- Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University, Baltimore, MD, USA
| | - Minxuan Huang
- Department of Epidemiology, Emory University, Atlanta, GA, USA
| | - Jeffrey B Palmer
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, 600 N. Wolfe St. - Phipps 181, Baltimore, MD, 21287, USA.,Department of Otolaryngology-Head and Neck Surgery and Center for Functional Anatomy and Evolution, Johns Hopkins University, Baltimore, MD, USA
| | - Dale M Needham
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, 600 N. Wolfe St. - Phipps 181, Baltimore, MD, 21287, USA.,Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University, Baltimore, MD, USA.,Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA
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24
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Iwasaki M, Taylor GW, Awano S, Yoshida A, Kataoka S, Ansai T, Nakamura H. Periodontal disease and pneumonia mortality in haemodialysis patients: A 7-year cohort study. J Clin Periodontol 2017; 45:38-45. [DOI: 10.1111/jcpe.12828] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2017] [Indexed: 01/10/2023]
Affiliation(s)
- Masanori Iwasaki
- Division of Community Oral Health Development; Kyushu Dental University; Kitakyushu Japan
| | - George W. Taylor
- Department of Preventive and Restorative Dental Sciences; University of California San Francisco; San Francisco CA USA
| | - Shuji Awano
- Department of Comprehensive Education; Kyushu Dental University; Kitakyushu Japan
| | - Akihiro Yoshida
- Department of Oral Microbiology; Matsumoto Dental University; Shiojiri Japan
| | - Shota Kataoka
- Division of Community Oral Health Development; Kyushu Dental University; Kitakyushu Japan
| | - Toshihiro Ansai
- Division of Community Oral Health Development; Kyushu Dental University; Kitakyushu Japan
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25
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Boyles TH, Brink A, Calligaro GL, Cohen C, Dheda K, Maartens G, Richards GA, van Zyl Smit R, Smith C, Wasserman S, Whitelaw AC, Feldman C. South African guideline for the management of community-acquired pneumonia in adults. J Thorac Dis 2017; 9:1469-1502. [PMID: 28740661 DOI: 10.21037/jtd.2017.05.31] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Tom H Boyles
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Adrian Brink
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, University of Cape Town, Cape Town, South Africa.,Ampath National Laboratory Services, Milpark Hospital, Johannesburg, South Africa
| | - Greg L Calligaro
- Lung Infection and Immunity Unit, Division of Pulmonology and UCT Lung Institute, University of Cape Town, Cape Town, South Africa
| | - Cheryl Cohen
- Centre for Respiratory Disease and Meningitis, National Institute for Communicable Diseases, Johannesburg, South Africa.,School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Keertan Dheda
- Lung Infection and Immunity Unit, Division of Pulmonology and UCT Lung Institute, University of Cape Town, Cape Town, South Africa
| | - Gary Maartens
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Guy A Richards
- Department of Critical Care, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Richard van Zyl Smit
- Lung Infection and Immunity Unit, Division of Pulmonology and UCT Lung Institute, University of Cape Town, Cape Town, South Africa
| | | | - Sean Wasserman
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Andrew C Whitelaw
- Division of Medical Microbiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa.,National Health Laboratory Service, Tygerberg Hospital, Cape Town, South Africa
| | - Charles Feldman
- Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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26
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Son YG, Shin J, Ryu HG. Pneumonitis and pneumonia after aspiration. J Dent Anesth Pain Med 2017; 17:1-12. [PMID: 28879323 PMCID: PMC5564131 DOI: 10.17245/jdapm.2017.17.1.1] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Revised: 02/19/2017] [Accepted: 02/20/2017] [Indexed: 12/25/2022] Open
Abstract
Aspiration pneumonitis and aspiration pneumonia are clinical syndromes caused by aspiration. These conditions are clinically significant due to their high morbidity and mortality. However, aspiration as a preceding event are often unwitnessed, particularly in cases of asymptomatic or silent aspiration. Furthermore, despite the difference in treatment approaches for managing aspiration pneumonitis and aspiration pneumonia, these two disease entities are often difficult to discriminate from one another, resulting in inappropriate treatment. The use of unclear terminologies hinders the comparability among different studies, making it difficult to produce evidence-based conclusions and practical guidelines. We reviewed the most recent studies to define aspiration, aspiration pneumonitis, and aspiration pneumonia, and to further assess these conditions in terms of incidence and epidemiology, pathophysiology, risk factors, diagnosis, management and treatment, and prevention.
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Affiliation(s)
- Young Gon Son
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jungho Shin
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Ho Geol Ryu
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
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Abstract
Nosocomial pneumonia, one of the most common hos pital-acquired infectious diseases, is associated with sub stantial morbidity and mortality, approaching 50% in selected patients. Patients with alterations in their tracheobronchial tree or natural host-defense mecha nisms are at increased risk of developing pneumonia. Organisms gain access to the normally sterile tracheo bronchial tree primarily by aspiration of colonized oro pharyngeal gastric secretions. Risk factors for bacterial colonization and the development of nosocomial pneu monia include increased age, elevated pH of gastric con tents, postoperative state, nutritional status, severe underlying disease (for example, chronic obstructive pulmonary disease), administration of corticosteroids or other immunosuppressive therapy, and intubation or mechanical ventilation. High gastric volume may also increase the chance of aspiration of secretions in some high-risk patients.
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Affiliation(s)
- Layne O. Gentry
- Infectious Disease Section, St Luke's Episcopal Hospital,
and the Departments of Microbiology and Immunology, Baylor College of Medicine,
Houston, TX
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28
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Hoyt J. Analytic Reviews : Aspiration Pneumonitis: Patient Risk Factors, Prevention, and Management. J Intensive Care Med 2016. [DOI: 10.1177/0885066690005001s02] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Occurrence of aspiration pneumonitis, the morbid con dition that often follows aspiration of gastric contents, has been documented for over 40 years. A number of risk factors that predispose patients to acid aspiration have been identified. The acidity of the gastric fluid and the volume of the aspirate are high-risk factors that de termine the severity of the pneumonitis. In this review I discuss those conditions that predispose patients to as piration and subsequent development of pneumonitis as well as current strategies for prevention and treatment.
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Abstract
Acute respiratory failure in pregnancy has multiple etiologies, including thromboembolism, amniotic fluid embolism, venous air embolism, aspiration of gastric contents, respiratory infections, asthma, beta-adrenergic tocolytic therapy, and pneumomediastinum and pneu mothorax. Proper management of acute respiratory fail ure in pregnancy requires an understanding of the specific diseases and the normal gestational changes that occur in maternal respiration (decreased functional re sidual capacity, increased minute ventilation, mild respi ratory alkalosis) and hemodynamics (increased cardiac output, increased blood and plasma volume, unchanged central pressures). Knowledge of the determinants of oxygen delivery to fetal tissue (uterine blood flow, pla cental transfer, fetal circulation) and how they are af fected by changes in maternal hemodynamics, position, acid-base status, and medications can help sustain nor mal fetal development, whenever possible, without compromising maternal care. Diagnostic testing such as radiography, hemodynamic monitoring, and fetal moni toring are considered in terms of attendant risk to the mother or the fetus, alterations in normal values related to gestation, and indications for usage. Similarly, the risks and benefits of supportive and specific therapies for the various etiologies of acute respiratory therapy are reviewed.
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Affiliation(s)
- Helen M. Hollingsworth
- From the Division of Pulmonary and Critical Care Medicine, University of Massachusetts Medical Center, Worcester, MA
| | - Melvin R. Pratter
- From the Division of Pulmonary and Critical Care Medicine, University of Massachusetts Medical Center, Worcester, MA
| | - Richard S. Irwin
- From the Division of Pulmonary and Critical Care Medicine, University of Massachusetts Medical Center, Worcester, MA
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30
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Les pneumonies d’inhalation. MEDECINE INTENSIVE REANIMATION 2016. [DOI: 10.1007/s13546-015-1155-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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31
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Aspiration Pneumonia in the Geriatric Population. CURRENT GERIATRICS REPORTS 2015. [DOI: 10.1007/s13670-015-0125-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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32
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Makic MBF, Rauen C, Watson R, Poteet AW. Examining the evidence to guide practice: challenging practice habits. Crit Care Nurse 2015; 34:28-45; quiz 46. [PMID: 24692464 DOI: 10.4037/ccn2014262] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Nurses are the largest segment of the nation's health care workforce, which makes nurses vital to the translation of evidence-based practice as a practice norm. Critical care nurses are in a position to critically appraise and apply best evidence in daily practice to improve patients' outcomes. It is important for critical care nurses to continually evaluate their current practice to ensure that they are applying the current best evidence rather than practicing on the basis of tradition. This article is based on a presentation at the 2013 National Teaching Institute of the American Association of Critical-Care Nurses. Four practice interventions that are within the realm of nursing are critiqued on the basis of current best evidence: (1) turning critically ill patients, (2) sleep promotion in the intensive care unit, (3) feeding tube management in infants and children, and (4) prevention of venothromboembolism…again. The related beliefs, current evidence, and implications for practice associated with each topic are described.
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33
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Teramoto S, Yoshida K, Hizawa N. Update on the pathogenesis and management of pneumonia in the elderly-roles of aspiration pneumonia. Respir Investig 2015; 53:178-84. [PMID: 26344607 DOI: 10.1016/j.resinv.2015.01.003] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 01/20/2015] [Accepted: 01/21/2015] [Indexed: 11/30/2022]
Abstract
Pneumonia in the elderly results in the highest mortality among cases of community-acquired pneumonia (CAP). The pathophysiology of pneumonia in the elderly is primarily due to aspiration pneumonia (ASP). ASP comprises two pathological conditions: airspace infiltration with bacterial pathogens and dysphagia-associated miss-swallowing. The first-line therapy for the treatment of bacterial pneumonia in the elderly is a narrow spectrum of antibiotics, including sulbactam/ampicillin, which are effective against major lower respiratory infection pathogens and anaerobes. The bacterial pathogens of ASP cases of pneumonia in the elderly are similar to those associated with adult CAP. In addition to an appropriate course of antibiotics, pharmacologic and non-pharmacologic approaches for dysphagia and upper airway management are necessary for the treatment and prevention of pneumonia. Swallowing rehabilitation, oral health care, pneumococcal vaccination, gastroesophageal reflux management, and a head-up position during the night are necessary for the treatment and prevention of repeated episodes of pneumonia in elderly patients. In addition, tuberculosis should always be considered for the differential diagnosis of pneumonia in this patient population.
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Affiliation(s)
- Shinji Teramoto
- Department of Pulmonary Medicine, Hitachinaka Medical Education and Research Center, University of Tsukuba, 20-1 Hitachinaka-shi, Ibaraki 329-8575, Japan.
| | - Kazufumi Yoshida
- Department of Pulmonary Medicine, Hitachinaka General Hospital, Hitachi Ltd., Ibaraki, Japan
| | - Nobuyuki Hizawa
- Department of Pulmonary Medicine, Graduate School of Comprehensive Human Science, University of Tsukuba, Ibaraki, Japan
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34
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Abstract
Pneumonia is a common disease that carries a high mortality. Traditionally, pneumonia has been classified and treated according to the setting where the pneumonia develops, namely community-acquired pneumonia, health-care-associated pneumonia, and hospital-acquired pneumonia. This classification was based on the risk of a patient being infected with a hospital-acquired drug-resistant pathogen. A new treatment paradigm has been proposed based on the risk of the patient being infected with a community-acquired drug-resistant pathogen. The risk factors for infection with a community-acquired drug-resistant pathogen include (1) hospitalization for > 2 days during the previous 90 days, (2) antibiotic use during the previous 90 days, (3) nonambulatory status, (4) tube feeds, (5) immunocompromised status, (6) use of acid-suppressive therapy, (7) chronic hemodialysis during the preceding 30 days, (8) positive methicillin-resistant Staphylococcus aureus history within the previous 90 days, and (9) present hospitalization > 2 days. This article reviews this new treatment paradigm and other issues relevant to the diagnosis and management of pneumonia based on information from MEDLINE, EMBASE, and the Cochrane Register of Controlled Trials.
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Affiliation(s)
- Paul E Marik
- Division of Pulmonary and Critical Care Medicine, Eastern Virginia Medical School , Norfolk, VA , USA
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35
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DiBardino DM, Wunderink RG. Aspiration pneumonia: a review of modern trends. J Crit Care 2014; 30:40-8. [PMID: 25129577 DOI: 10.1016/j.jcrc.2014.07.011] [Citation(s) in RCA: 155] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Revised: 07/14/2014] [Accepted: 07/15/2014] [Indexed: 01/18/2023]
Abstract
PURPOSE The purpose was to describe aspiration pneumonia in the context of other lung infections and aspiration syndromes and to distinguish between the main scenarios commonly implied when the terms aspiration or aspiration pneumonia are used. Finally, we aim to summarize current evidence surrounding the diagnosis, microbiology, treatment, risks, and prevention of aspiration pneumonia. MATERIALS AND METHODS Medline was searched from inception to November 2013. All descriptive or experimental studies that added to the understanding of aspiration pneumonia were reviewed. All studies that provided insight into the clinical aspiration syndromes, historical context, diagnosis, microbiology, risk factors, prevention, and treatment were summarized within the text. RESULTS Despite the original teaching, aspiration pneumonia is difficult to distinguish from other pneumonia syndromes. The microbiology of pneumonia after a macroaspiration has changed over the last 60 years from an anaerobic infection to one of aerobic and nosocomial bacteria. Successful antibiotic therapy has been achieved with several antibiotics. Various risks for aspiration have been described leading to several proposed preventative measures. CONCLUSIONS Aspiration pneumonia is a disease with a distinct pathophysiology. In the modern era, aspiration pneumonia is rarely solely an anaerobic infection. Antibiotic treatment is largely dependent on the clinical scenario. Several measures may help prevent aspiration pneumonia.
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Affiliation(s)
- David M DiBardino
- Department of Pulmonary, Allergy, and Critical Care Medicine, Columbia University, New York, NY.
| | - Richard G Wunderink
- Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
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36
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Allewelt M. Aspiration pneumonia and primary lung abscess: diagnosis and therapy of an aerobic or an anaerobic infection? Expert Rev Respir Med 2014; 1:111-9. [DOI: 10.1586/17476348.1.1.111] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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37
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Abstract
Disinfection of the face and mucosa lined surfaces of the nose and mouth using a povidone-iodine (PI) or Betadine solution is common practice among head and neck surgeons. Povidone-iodine, which is a highly effective broad-spectrum antibiotic effective against bacteria, viruses, fungi, and protozoa, decreases the risk of postoperative surgical wound infection. We report a case of PI aspiration causing an acute chemical pneumonitis after preoperative disinfection of the oral cavity and nasopharynx in preparation for cleft palate repair. As a result of the inflammatory response, the patient required positive pressure mechanical ventilation and a prolonged stay in the pediatric intensive care unit. The patient was safely extubated on hospital day 7 and discharged on hospital day 10 without any long-term sequelae on follow-up. We also review the 3 other reported cases of PI aspiration pneumonitis. Based on our case report and literature review, we conclude that PI aspiration is associated with a high rate of morbidity; however, this should not preclude the use of PI before surgery, given its effectiveness as an oral disinfectant and the exceedingly low incidence of aspiration.
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38
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Miyake N, Kawamoto K, Fujiwara K, Hasegawa Y, Kitano H. Subglottic laryngeal closure: a unique modified method of laryngotracheal separation to prevent aspiration. Ann Otol Rhinol Laryngol 2013; 122:427-34. [PMID: 23951693 DOI: 10.1177/000348941312200703] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Laryngotracheal separation (LTS) is an ideal surgical method for intractable aspiration; however, the oral side of the tracheal stump can easily disintegrate. Therefore, we developed a modified LTS method. We performed subglottic laryngeal closure (SGLC) as a new surgical method and evaluated the outcomes. METHODS We retrospectively analyzed the medical records of 36 patients (28 male and 8 female; 15 to 91 years of age) who underwent SGLC between 2007 and 2011 at Tottori University Hospital, Japan. Operative data (operative time, intraoperative bleeding, and time to drain removal), outcomes (aspiration and changes in nutritional status), and complications with regard to the surgical method were examined. The occurrence of a subcutaneous proximal laryngeal stump fistula was evaluated by videofluoroscopy. RESULTS The SGLC was performed safely in all patients. Fistulization was observed in only 1 of the patients (2.8%), and major bleeding after surgery was observed in 1 patient (2.8%). The procedure relieved aspiration pneumonia in all patients. CONCLUSIONS We conclude that SGLC is effective for treating and preventing pulmonary aspiration. The incidence of postoperative complications, particularly that of subcutaneous fistulas, was very low. Therefore, this method may be useful for patients in poor condition.
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Affiliation(s)
- Naritomo Miyake
- Department of Sensory and Motor Organs, Division of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, Tottori University, Yonago, Japan
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39
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Waybright RA, Coolidge W, Johnson TJ. Treatment of clinical aspiration: A reappraisal. Am J Health Syst Pharm 2013; 70:1291-300. [DOI: 10.2146/ajhp120319] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Ryan A. Waybright
- Avera McKennan Hospital and University Health Center (AMHUHC), Sioux Falls, SD; at the time of writing he was Postgraduate Year 2 (PGY2) Critical Care Pharmacy Resident, AMHUHC
| | - William Coolidge
- AMHUHC; at the time of writing he was PGY2 Critical Care Pharmacy Resident, AMHUHC
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40
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Gerek M, Çiyiltepe M. Dysphagia Management of Pediatric Patients with Cerebral Palsy. ACTA ACUST UNITED AC 2013. [DOI: 10.1179/096979505799103849] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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41
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Bronchoalveolar Lavage Amylase Is Associated With Risk Factors for Aspiration and Predicts Bacterial Pneumonia*. Crit Care Med 2013; 41:765-73. [DOI: 10.1097/ccm.0b013e31827417bc] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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42
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43
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Parthasarathi K. Endothelial connexin43 mediates acid-induced increases in pulmonary microvascular permeability. Am J Physiol Lung Cell Mol Physiol 2012; 303:L33-42. [PMID: 22561459 DOI: 10.1152/ajplung.00219.2011] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Acid aspiration, a common cause of acute lung injury, leads to alveolar edema. Increase in lung vascular permeability underlies this pathology. To define mechanisms, isolated rat lungs were perfused with autologous blood. Hydrochloric acid and rhodamine-dextran 70 kDa (RDx70) were coinstilled into an alveolus by micropuncture. RDx70 fluorescence was used to establish the spatial distribution of acid. Subsequently, FITC-dextran 20 kDa (FDx20) was infused into microvessels for 60 min followed by a 10-min HEPES-buffered saline wash. During the infusion, FITC fluorescence changes were recorded to quantify the ratio of peak to postwash fluorescence. The ratio, termed normalized fluorescence, was low for acid compared with buffer instillation both in microvessels abutting acid-treated alveoli and those located more than 700 μm away. In contrast, the normalized fluorescence was similar to buffer controls when a higher molecular weight tracer (FITC-dextran 70 kDa) was infused instead of FDx20, suggesting that normalized FDx20 fluorescence faithfully represented microvascular permeability. Inhibiting endothelial connexin43 (Cx43) gap junction communication with Gap27 blunted the acid-induced reduction in normalized fluorescence, although scrambled Gap27 did not have any effect. The blunting was evident not only in microvessels away from the site of injury, but also in those abutting directly injured alveoli. Thus the new fluorescence-based method reveals that acid increases microvascular permeability both at acid-instilled and away sites. Inhibiting endothelial Cx43 blocked the permeability increase even at the direct injury sites. These data indicate for the first time that Cx43-dependent mechanisms mediate acid-induced increases in microvascular permeability. Cx43 may be a therapeutic target in acid injury.
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44
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Bartlett JG. Anaerobic bacterial infection of the lung. Anaerobe 2012; 18:235-9. [DOI: 10.1016/j.anaerobe.2011.12.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2011] [Revised: 12/05/2011] [Accepted: 12/07/2011] [Indexed: 10/14/2022]
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45
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Swallowing disorders, pneumonia and respiratory tract infectious disease in the elderly. Rev Mal Respir 2011; 28:e76-93. [DOI: 10.1016/j.rmr.2011.09.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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46
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Gomes-Filho IS, Passos JS, Seixas da Cruz S. Respiratory disease and the role of oral bacteria. J Oral Microbiol 2010; 2:10.3402/jom.v2i0.5811. [PMID: 21523216 PMCID: PMC3084574 DOI: 10.3402/jom.v2i0.5811] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
The relationship between oral health and systemic conditions, including the association between poor oral hygiene, periodontal disease, and respiratory disease, has been increasingly debated over recent decades. A considerable number of hypotheses have sought to explain the possible role of oral bacteria in the pathogenesis of respiratory diseases, and some clinical and epidemiological studies have found results favoring such an association. This review discusses the effect of oral bacteria on respiratory disease, briefly introduces the putative biological mechanisms involved, and the main factors that could contribute to this relationship. It also describes the role of oral care for individuals who are vulnerable to respiratory infections.
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Affiliation(s)
| | - Johelle S. Passos
- Department of Periodontics, Feira de Santana State University, Bahia, Brazil
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47
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Choi YS, Kang SH, Kim MK, Lee CU, Yoo JH. Crown removal and endodontic drainage as a last method in active gingival bleeding with liver cirrhosis and periodontitis: a case report. J Korean Assoc Oral Maxillofac Surg 2010. [DOI: 10.5125/jkaoms.2010.36.3.221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Young-Su Choi
- Department of Oral and Maxillofacial Surgery, National Health Insurance Corporation Ilsan Hospital, Goyang, Korea
| | - Sang-Hoon Kang
- Department of Oral and Maxillofacial Surgery, National Health Insurance Corporation Ilsan Hospital, Goyang, Korea
| | - Moon-Key Kim
- Department of Oral and Maxillofacial Surgery, National Health Insurance Corporation Ilsan Hospital, Goyang, Korea
| | - Chun-Ui Lee
- Department of Oral and Maxillfacial Surgery, College of Dentistry, Wonju Christian Hospital, Yonsei University, Wonju, Korea
| | - Jae-Ha Yoo
- Department of Oral and Maxillfacial Surgery, College of Dentistry, Wonju Christian Hospital, Yonsei University, Wonju, Korea
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48
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Mo DY, Yoo JH, Choi BH, Sul SH, Kim HR, Lee CU. Emergency bleeding control in a mentally retarded patient with active oral and maxillofacial bleeding injuries: report of a case. J Korean Assoc Oral Maxillofac Surg 2010. [DOI: 10.5125/jkaoms.2010.36.4.303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Dong-Yub Mo
- Department of Oral and Maxillofacial Surgery, Wonju Christian Hospital, College of Dentistry, Yonsei University, Wonju, Korea
| | - Jae-Ha Yoo
- Department of Oral and Maxillofacial Surgery, Wonju Christian Hospital, College of Dentistry, Yonsei University, Wonju, Korea
| | - Byung-Ho Choi
- Department of Oral and Maxillofacial Surgery, Wonju Christian Hospital, College of Dentistry, Yonsei University, Wonju, Korea
| | - Sung-Han Sul
- Department of Oral and Maxillofacial Surgery, Wonju Christian Hospital, College of Dentistry, Yonsei University, Wonju, Korea
| | - Ha-Rang Kim
- Department of Oral and Maxillofacial Surgery, Wonju Christian Hospital, College of Dentistry, Yonsei University, Wonju, Korea
| | - Chun-Ui Lee
- Department of Oral and Maxillofacial Surgery, Wonju Christian Hospital, College of Dentistry, Yonsei University, Wonju, Korea
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49
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Puisieux F, D'andrea C, Baconnier P, Bui-Dinh D, Castaings-Pelet S, Crestani B, Desrues B, Ferron C, Franco A, Gaillat J, Guenard H, Housset B, Jeandel C, Jebrak G, Leymarie-Selles A, Orvoen-Frija E, Piette F, Pinganaud G, Salle JY, Strubel D, Vernejoux JM, De Wazières B, Weil-Engerer S. [Swallowing disorders, pneumonia and respiratory tract infectious disease in the elderly]. Rev Mal Respir 2009; 26:587-605. [PMID: 19623104 DOI: 10.1016/s0761-8425(09)74690-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Swallowing disorders (or dysphagia) are common in the elderly and their prevalence is often underestimated. They may result in serious complications including dehydration, malnutrition, airway obstruction, aspiration pneumonia (infectious process) or pneumonitis (chemical injury caused by the inhalation of sterile gastric contents). Moreover the repercussions of dysphagia are not only physical but also emotional and social, leading to depression, altered quality of life, and social isolation. While some changes in swallowing may be a natural result of aging, dysphagia in the elderly is mainly due to central nervous system diseases such as stroke, parkinsonism, dementia, medications, local oral and oesophageal factors. To be effective, management requires a multidisciplinary team approach and a careful assessment of the patient's oropharyngeal anatomy and physiology, medical and nutritional status, cognition, language and behaviour. Clinical evaluation can be completed by a videofluoroscopic study which enables observation of bolus movement and movements of the oral cavity, pharynx and larynx throughout the swallow. The treatment depends on the underlying cause, extent of dysphagia and prognosis. Various categories of treatment are available, including compensatory strategies (postural changes and dietary modification), direct or indirect therapy techniques (swallow manoeuvres, medication and surgical procedures).
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Affiliation(s)
- F Puisieux
- Service de Gériatrie, Hôpital des Bateliers, CHRU de Lille, France.
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50
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Manrique D, Sato J. Salivary gland surgery for control of chronic pulmonary aspiration in children with cerebral palsy. Int J Pediatr Otorhinolaryngol 2009; 73:1192-4. [PMID: 19535155 DOI: 10.1016/j.ijporl.2009.05.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2009] [Revised: 05/02/2009] [Accepted: 05/05/2009] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate the outcome of surgical saliva reduction to decrease pulmonary aspiration in children with cerebral palsy and its repercussions in respiratory infection control. METHODS Twenty-nine children with neurological impairment and diagnosis of chronic pulmonary aspiration were submitted to bilateral submandibular gland excision and bilateral parotid duct ligation at the Association for the Welfare of Physically Handicapped Children, from December 2001 to December 2004. Postoperative frequency of lower respiratory tract infection, hospitalization rate due to pulmonary infection and airway secretion level after the surgery were compared to preoperative period. RESULTS Twenty-nine children with cerebral palsy aged 18 months to 9 years were submitted to submandibular glands excision and parotid ducts ligation. All children had gastrostomy and no oral intake. There were no major complications; two children had reopening of one parotid duct. Frequency of lower respiratory tract infections, rate of hospitalization for treatment of pulmonary infections and level of airway secretion were statistically reduced. Preoperative mean rate of lower respiratory tract infection was 6.9/year; in postoperative period, rate was 2.4/year (p<0.001). Pneumonia hospitalization mean rate was 63.4 days/year preoperatively and 17.5 days/year postoperatively (p<0.001). There was also a significant improvement in the need for suctioning of upper airway secretion (mean 11 times/day in preoperative period and 3.1 times/day in the postoperative period; p<0.001). CONCLUSION In children with cerebral palsy, surgical saliva reduction by submandibular glands excision and parotid ducts ligation is an effective and safe technique for frequency reduction of lower respiratory tract infection and level of airway secretion.
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Affiliation(s)
- Dayse Manrique
- Association for the Welfare of Physically Handicapped Children, Federal University of São Paulo, Av. Prof. Ascendino Reis 724, Ibirapuera, São Paulo (SP), Brazil.
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