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Song JE, Ji E, Kim NH, Ohn JH, Lim Y, Lee J, Kim HW, Kim SW, Ryu J, Park HS, Kim ES. Efficacy of an Aspiration Prevention Program That Utilizes the Gugging Swallowing Screen in Older Patients. Clin Interv Aging 2024; 19:1461-1470. [PMID: 39188524 PMCID: PMC11346477 DOI: 10.2147/cia.s474569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Accepted: 08/02/2024] [Indexed: 08/28/2024] Open
Abstract
Purpose Older patients have a higher risk of aspiration pneumonia and mortality if they are hospitalized. We aimed to assess the effectiveness of an aspiration prevention quality improvement (QI) program that utilizes the Gugging Swallowing Screen (GUSS) in older patients. Patients and Methods This retrospective cohort study was conducted in an acute medical care unit of a tertiary hospital in South Korea. The study used one-to-one propensity matching and included 96 patients who received the QI program and 96 who did not. All patients were aged 65 years or older and had risk factors for aspiration, including neurological and non-neurological disorders, neuromuscular disorders, impaired airway defenses, and dysphagia due to esophageal or gastrointestinal disorders. The primary outcomes included the duration of the fasting period during hospitalization, changes in nutritional status before admission and at discharge, in-hospital mortality, and readmission due to pneumonia within 90 days. Results Fasting period, changes in weight and albumin levels upon discharge after hospitalization, and length of stay did not differ significantly between patients in the GUSS and non-GUSS groups. However, the risk of readmission within 90 days was significantly lower in patients who underwent the GUSS than in those who did not (hazard ratio, 0.085; 95% confidence interval, 0.025-0.290; p = 0.001). Conclusion The GUSS aspiration prevention program effectively prevented readmission due to pneumonia within 90 days in older patients with acute illnesses. This implies that the adoption of efficient aspiration prevention methods in older patients with acute illnesses could play a pivotal role by enhancing patient outcomes and potentially mitigating the healthcare costs linked to readmissions.
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Affiliation(s)
- Ji Eun Song
- Hospital Medicine Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Eunjeong Ji
- Medical Research Collaborating Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Nak-Hyun Kim
- Hospital Medicine Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Jung Hun Ohn
- Hospital Medicine Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Yejee Lim
- Hospital Medicine Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Jongchan Lee
- Hospital Medicine Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Hye Won Kim
- Hospital Medicine Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Sun-Wook Kim
- Hospital Medicine Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Jiwon Ryu
- Hospital Medicine Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Hee-Sun Park
- Hospital Medicine Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Eun Sun Kim
- Hospital Medicine Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
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O'Keeffe ST. The challenge of making better decisions about oral intake in older people with 'aspiration pneumonia'. Eur Geriatr Med 2024; 15:877-879. [PMID: 38801475 DOI: 10.1007/s41999-024-00996-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Affiliation(s)
- Shaun T O'Keeffe
- Department of Geriatric Medicine, Galway University Hospitals, Galway, Ireland.
- Merlin Park University Hospital, Unit 4, Galway, Ireland.
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de Leon J, Ruan CJ, Schoretsanitis G, Villasante-Tezanos AG, Spina E, Sanz EJ, Betancort M, De Las Cuevas C. Investigating in VigiBase over 6000 cases of pneumonia in clozapine-treated patients in the context of the literature: focus on high lethality and the association with aspiration pneumonia. Expert Opin Drug Metab Toxicol 2024:1-15. [PMID: 38920369 DOI: 10.1080/17425255.2024.2373111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 06/15/2024] [Indexed: 06/27/2024]
Abstract
BACKGROUND The literature associates clozapine with pneumonia/aspiration pneumonia. RESEARCH DESIGN AND METHODS The international pharmacovigilance database (VigiBase™) uses the information component (IC) as statistical signal. VigiBase clozapine reports were analyzed for pneumonia/aspiration pneumonia from introduction to 10 May 2023. RESULTS There were 6392 cases of all types of pneumonia (5572 cases of pneumonia, 775 of aspiration pneumonia, and 45 combined). The IC was 3.52 for aspiration pneumonia, introduced as a VigiBase label in 2003, and 1.91 for pneumonia. Patients were reclassified as 3628 with no signs of aspiration and 1533 with signs. Signs of aspiration were strongly associated with some co-medications: olanzapine, odds ratio (OR) = 23.8, 95% confidence interval (CI), 14.9-38.0; risperidone OR = 18.6, CI, 11.4-30.4; valproic acid, OR = 5.5, CI, 4.5-6.6; and benzodiazepines OR = 5.5, CI, 4.5-6.6. In 2415 cases with completed data, fatal outcomes made up 45% (signs of aspiration made no difference), but there was wide variability from 0% (females <45 years of age; duration ≤30 days) to 76% (males >64 years of age; duration >1 year). During the first week, pneumonia was associated with 1) very high titration doses, 2) very small doses in Parkinson's disease, and 3) Japan vs other countries. CONCLUSIONS In clozapine-treated patients: 1) at least 30% of pneumonia cases may be aspiration pneumonia, 2) stopping some co-medications may decrease the risk of aspiration pneumonia, 3) average lethality in pneumonia was 45% but may be around 75% in geriatric patients with long-term treatment, and 4) safer titrations may sometimes require 5-mg tablets.
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Affiliation(s)
- Jose de Leon
- Mental Health Research Center, Eastern State Hospital, Lexington, KY, USA
- Biomedical Research Centre in Mental Health Net (CIBERSAM), Santiago Apóstol Hospital, University of the Basque Country, Vitoria, Spain
| | - Can-Jun Ruan
- Laboratory of Clinical Psychopharmacology, Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- The National Clinical Research Centre for Mental Disorders & Beijing Key Lab of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Georgios Schoretsanitis
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zürich, Zürich, Switzerland
- The Zucker Hillside Hospital, Psychiatry Research, Northwell Health, Glen Oaks, NY, USA
- Department of Psychiatry, Zucker School of Medicine at Northwell/Hofstra, Hempstead, NY, USA
| | | | - Edoardo Spina
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Emilio J Sanz
- Department of Physical Medicine and Pharmacology, School of Medicine, Universidad de La Laguna, La Laguna, Canary Islands, Spain
| | - Moisés Betancort
- Department of Clinical Psychology, Psychobiology, and Methodology, Universidad de La Laguna, La Laguna, Canary Islands, Spain
| | - Carlos De Las Cuevas
- Department of Internal Medicine, Dermatology and Psychiatry and Instituto Universitario de Neurociencia (IUNE), Universidad de La Laguna, La Laguna, Canary Islands, Spain
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Delforge Q, Gaudet A, Boddaert P, Wallet F, Voisin B, Nseir S. Accuracy of the Infectious Diseases Society of America and British Thoracic Society Criteria for Acute Pneumonia in Differentiating Chemical and Bacterial Complications of Aspiration in Comatose Ventilated Patients Following Drug Poisoning. Antibiotics (Basel) 2024; 13:495. [PMID: 38927162 PMCID: PMC11200670 DOI: 10.3390/antibiotics13060495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 05/24/2024] [Accepted: 05/25/2024] [Indexed: 06/28/2024] Open
Abstract
Drug poisoning frequently leads to admission to intensive care units, often resulting in aspiration, a potentially life-threatening condition if not properly managed. Aspiration can manifest as either bacterial aspiration pneumonia (BAP) or aspiration pneumonitis (AP), which are challenging to distinguish potentially leading to overprescription of antibiotics and the emergence of multidrug-resistant bacteria. This study aims to assess the accuracy of the Infectious Diseases Society of America (IDSA) and British Thoracic Society (BTS) criteria in differentiating BAP from AP in comatose ventilated patients following drug poisoning. This cross-sectional study included 95 patients admitted for drug poisoning at the Lille University Hospital intensive care department, between 2013 and 2017, requiring mechanical ventilation and receiving antibiotics for aspiration. Patients were categorized as having bacterial complications if tracheal sampling yielded positive culture results, and if they were otherwise considered to have chemical complications. The sensitivity, specificity, positive predictive value, and negative predictive value of IDSA and BTS criteria in identifying patients with bacterial complications were evaluated. Among the patients, 34 (36%) experienced BAP. The IDSA criteria demonstrated a sensitivity of 62% and specificity of 33%, while the BTS criteria showed a sensitivity of 50% and specificity of 38%. Both the IDSA and BTS criteria exhibited poor sensitivity and specificity in identifying microbiologically confirmed pneumonia in comatose ventilated patients following drug poisoning.
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Affiliation(s)
- Quentin Delforge
- Pôle Médecine Intensive-Réanimation, Hôpital Roger Salengro, CHU de Lille, 59000 Lille, France (A.G.)
| | - Alexandre Gaudet
- Pôle Médecine Intensive-Réanimation, Hôpital Roger Salengro, CHU de Lille, 59000 Lille, France (A.G.)
- CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019-UMR9017-CIIL-Centre d’Infection et d’Immunité de Lille, Pôle de Médecine Intensive-Réanimation, Université de Lille, 59000 Lille, France
| | - Pauline Boddaert
- Pôle Médecine Intensive-Réanimation, Hôpital Roger Salengro, CHU de Lille, 59000 Lille, France (A.G.)
| | - Frédéric Wallet
- Laboratoire de Microbiologie, CHRU de Lille, 2 Avenue Oscar Lambret, 59000 Lille, France
| | - Benoit Voisin
- Pôle Médecine Intensive-Réanimation, Hôpital Roger Salengro, CHU de Lille, 59000 Lille, France (A.G.)
| | - Saad Nseir
- Pôle Médecine Intensive-Réanimation, Hôpital Roger Salengro, CHU de Lille, 59000 Lille, France (A.G.)
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Oi I, Ito I, Tanabe N, Konishi S, Ibi Y, Hidaka Y, Hamao N, Shirata M, Nishioka K, Imai S, Yasutomo Y, Kadowaki S, Hirai T. Investigation of predictors for in-hospital death or long-term hospitalization in community-acquired pneumonia with risk factors for aspiration. Eur Clin Respir J 2024; 11:2335721. [PMID: 38586609 PMCID: PMC10997353 DOI: 10.1080/20018525.2024.2335721] [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: 10/03/2023] [Accepted: 03/22/2024] [Indexed: 04/09/2024] Open
Abstract
Background It is known that the mortality of pneumonia in patients with risk factors for aspiration is worse than that in those without these risk factors. However, it is still unknown which risk factors for aspiration predict prognosis. Therefore, we aimed to determine which risk factors for aspiration are associated with death or prolonged hospitalization. Methods We prospectively followed patients with community-acquired pneumonia at a single hospital providing acute to chronic care in Japan until they died or were discharged. Patients at any risk of aspiration were included. The associations between pneumonia severity, individual risk factors for aspiration, and in-hospital death or prolonged hospitalization were investigated. Overall survival was estimated by the Kaplan - Meier method, and the factors associated with in-hospital death or prolonged hospitalization were investigated by multivariate analysis using factors selected by a stepwise method. Results In total, 765 patients with pneumonia and risk factors for aspiration were recruited. One hundred and ten patients deceased, and 259 patients were hospitalized over 27 days. In-hospital death increased as the number of risk factors for aspiration increased. In the multivariate analysis, male, impaired consciousness, acidemia, elevated blood urea nitrogen, and bedridden status before the onset of pneumonia were associated with in-hospital death (odds ratio [OR]: 2.5, 2.5, 3.6, 3.1, and 2.6; 95% confidence interval [CI]: 1.6-4.1, 1.4-4.2, 1.6-8.0, 1.9-5.0, and 1.6-4.2 respectively). In the Cox regression analysis, these factors were also associated with in-hospital death. None of the vital signs at admission were associated. Tachycardia, elevated blood urea nitrogen, hyponatremia, and bedridden status were associated with hospitalization for >27 days (OR: 4.1, 2.3, 4.3, and 2.9; 95% CI: 1.3-12.9, 1.5-3.4, 2.0-9.4, and 2.0-4.0, respectively). Conclusions Blood sampling findings and bedridden status are useful for predicting in-hospital mortality and long-term hospitalization in patients with pneumonia and any risk factor for aspiration.
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Affiliation(s)
- Issei Oi
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Kyoto, Japan
| | - Isao Ito
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Kyoto, Japan
- Department of Internal Medicine, Ono Municipal Hospital, Ono, Hyogo, Japan
| | - Naoya Tanabe
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Kyoto, Japan
- Department of Internal Medicine, Ono Municipal Hospital, Ono, Hyogo, Japan
| | - Satoshi Konishi
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Kyoto, Japan
- Department of Internal Medicine, Ono Municipal Hospital, Ono, Hyogo, Japan
| | - Yumiko Ibi
- Department of Biomedical Statistics and Bioinformatics, Graduate School of Medicine, Kyoto University, Kyoto, Kyoto, Japan
| | - Yu Hidaka
- Department of Biomedical Statistics and Bioinformatics, Graduate School of Medicine, Kyoto University, Kyoto, Kyoto, Japan
| | - Nobuyoshi Hamao
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Kyoto, Japan
| | - Masahiro Shirata
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Kyoto, Japan
| | - Kensuke Nishioka
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Kyoto, Japan
| | - Seiichiro Imai
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Kyoto, Japan
| | - Yoshiro Yasutomo
- Department of Internal Medicine, Ono Municipal Hospital, Ono, Hyogo, Japan
| | - Seizo Kadowaki
- Department of Internal Medicine, Ono Municipal Hospital, Ono, Hyogo, Japan
| | - Toyohiro Hirai
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Kyoto, Japan
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6
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Patel J, Sohal A, Chaudhry H, Kalra S, Kohli I, Singh I, Dukovic D, Yang J. Predictors and impact of aspiration pneumonia in patients undergoing esophagogastroduodenoscopy: national inpatient sample 2016-2020. Eur J Gastroenterol Hepatol 2024; 36:298-305. [PMID: 38179867 DOI: 10.1097/meg.0000000000002698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Abstract
OBJECTIVES Aspiration pneumonia is a rare but feared complication among patients undergoing esophagogastroduodenoscopy (EGD). Our study aims to assess the incidence as well as risk factors for aspiration pneumonia in patients undergoing EGD. METHODS National Inpatient Sample 2016-2020 was used to identify adult patients undergoing EGD. Patients were stratified into two groups based on the presence of aspiration pneumonia. Multivariate logistic regression analysis was performed to identify the risk factors associated with aspiration pneumonia. We adjusted for patient demographics, Elixhauser comorbidities and hospital characteristics. RESULTS Of the 1.8 million patients undergoing EGD, 1.9% of the patients developed aspiration pneumonia. Patients with aspiration pneumonia were mostly males (59.54%), aged >65 years old (66.19%), White (72.2%), had Medicare insurance (70.5%) and were in the lowest income quartile (28.7%). On multivariate analysis, the age >65 group, White race, congestive heart failure (CHF), neurological disorders and chronic obstructive pulmonary disease were associated with higher odds of aspiration pneumonia. This complication was associated with higher in-hospital mortality (9% vs. 0.8%; P < 0.001) and longer length of stay (10.54 days vs. 4.85 days; P < 0.001). CONCLUSION Our study found that rates of post-EGD aspiration pneumonia are increasing. We found a significant association between various comorbidities and aspiration pneumonia. Our data suggests that we need to optimize these patients before EGD, as the development of aspiration is associated with worsened outcomes. Further prospective studies are needed to clarify these associations.
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Affiliation(s)
- Jay Patel
- Department of Gastroenterology, Hepatology, and Nutrition, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio
| | - Aalam Sohal
- Department of Hepatology, Liver Institute Northwest, Seattle, Washington
| | - Hunza Chaudhry
- Department of Internal Medicine, University of California, San Francisco-Fresno, California, USA
| | - Shivam Kalra
- Department of Medicine, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Isha Kohli
- Department of Graduate Public Health, Icahn School of Medicine, Mount Sinai, New York
| | - Ishandeep Singh
- Department of Medicine, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Dino Dukovic
- Department of Internal Medicine, Ross University School of Medicine, Bridgetown, Barbados
| | - Juliana Yang
- Department of Gastroenterology and Hepatology, The University of Texas Medical Branch, Galveston, Texas, USA
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Ueda A, Nohara K. Criteria for diagnosing aspiration pneumonia in Japan - A scoping review. Respir Investig 2024; 62:128-136. [PMID: 38113576 DOI: 10.1016/j.resinv.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 08/12/2023] [Accepted: 11/22/2023] [Indexed: 12/21/2023]
Abstract
Aspiration pneumonia accounts for a significantly higher proportion of pneumonia cases in Japan than in Western countries. We conducted a scoping review of the criteria for diagnosing aspiration pneumonia in the literature on aspiration pneumonia reported from Japan, where the incidence of aspiration pneumonia is higher than in Europe and the United States. We searched MEDLINE and the Cochrane Library as literature databases. The search keywords were "aspiration," "pneumonia," and "Japan," combined with AND. After eliminating duplicates, we screened 852 articles and reviewed 112 articles in full, with 58 articles included in the final analysis. Of the 58 articles, 25 adopted the clinical diagnostic criteria for aspiration pneumonia proposed by the Japanese Study Group on Aspiration Pulmonary Disease. The remaining 33 articles used their own diagnostic criteria. There were 12 articles that described the features of images. There were three articles stating that aspiration pneumonitis should be excluded. There were five reports in which all patients were examined for swallowing function disorder. In Japan, the diagnostic criteria for aspiration pneumonia proposed by the Japanese Study Group on Aspiration Pulmonary Disease were used extensively, and various other criteria were also used. Aspiration pneumonia diagnosed according to different criteria should be carefully compared in terms of incidence, therapeutic effects, and prognosis.
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Affiliation(s)
- Akihito Ueda
- Medical Corporation Toujinkai, Fujitate Hospital, Osaka-hu, 535-0002, Japan; Doctoral Program in Pharmaceutical Sciences, Graduate School of Pharmaceutical Sciences, Teikyo Heisei University, Nakano-ku, Tokyo, 164-8530, Japan.
| | - Kanji Nohara
- Department of Oral-Facial Disorders, Functional Oral Neuroscience, Graduate School of Dentistry Osaka University, Suita-city, Osaka, 565-0871, Japan
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Jain A, Raval M, Srikanth S, Modi K, Raju AR, Garg M, Doshi R, Desai R. In-hospital Outcomes of Aspiration Pneumonia Hospitalizations With Acute Heart Failure: A Nationwide Analysis. INTERNATIONAL JOURNAL OF HEART FAILURE 2023; 5:191-200. [PMID: 37937201 PMCID: PMC10625882 DOI: 10.36628/ijhf.2023.0014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 06/19/2023] [Accepted: 06/28/2023] [Indexed: 11/09/2023]
Abstract
Background and Objectives There is a paucity of data regarding the impact of acute heart failure (AHF) on the outcomes of aspiration pneumonia (AP). Methods Using National Inpatient Sample datasets (2016 to 2019), we identified admissions for AP with AHF vs. without AHF using relevant International Classification of Diseases, Tenth Revision codes. We compared the demographics, comorbidities, and outcomes between the two groups. Results Out of the 121,097,410 weighted adult hospitalizations, 488,260 had AP, of which 13.25% (n=64,675) had AHF. The AHF cohort consisted predominantly of the elderly (mean age 80.4 vs. 71.1 years), females (47.8% vs. 42.2%), and whites (81.6% vs. 78.5%) than non-AHF cohort (all p<0.001). Complicated diabetes and hypertension, dyslipidemia, obesity, chronic pulmonary disease, and prior myocardial infarction were more frequent in AHF than in the non-AHF cohort. AP-AHF cohort had similar adjusted odds of all-cause mortality (adjusted odds ratio [AOR], 0.9; 95% confidence interval [CI], 0.78-1.03; p=0.122), acute respiratory failure (AOR, 1.0; 95% CI, 0.96-1.13; p=0.379), but higher adjusted odds of cardiogenic shock (AOR, 2.2; 95% CI, 1.30-3.64; p=0.003), and use of mechanical ventilation (MV) (AOR, 1.3; 95% CI, 1.17-1.56; p<0.001) compared to AP only cohort. AP-AHF cohort more frequently required longer durations of MV and hospital stays with a higher mean cost of the stay. Conclusions Our study from a nationally representative database demonstrates an increased morbidity burden, worsened complications, and higher hospital resource utilization, although a similar risk of all-cause mortality in AP patients with AHF vs. no AHF.
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Affiliation(s)
- Akhil Jain
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Maharshi Raval
- Internal Medicine, Landmark Medical Center, Woonsocket, RI, USA
| | | | - Karnav Modi
- Division of Research, Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Athul Raj Raju
- Internal Medicine, Karuna Medical College, Kerala, India
| | | | - Rajkumar Doshi
- Cardiology, St Joseph’s University Medical Center, Paterson, NJ, USA
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9
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Kato Y, Hori S, Ushida K, Shimizu M, Shirai Y, Momosaki R. Association between the amount of rehabilitation and the outcomes in patients with aspiration pneumonia. Int J Rehabil Res 2023; 46:216-220. [PMID: 37039603 DOI: 10.1097/mrr.0000000000000581] [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: 04/12/2023]
Abstract
The appropriate amount of rehabilitation for aspiration pneumonia remains unknown. We conducted a historical cohort study to investigate the association between the amount of rehabilitation provided and the outcome of patients with aspiration pneumonia. A total of 4148 patients with aspiration pneumonia recruited from a database created by JMDC were categorized into three groups based on daily rehabilitation units: none or <1 unit (low-volume group), 1-2 units (medium-volume group), and more than 2 units (high-volume group). The main outcome measures were death in the hospital, discharge home, and length of hospital stay. The results showed that the middle-volume and high-volume groups had significantly fewer in-hospital deaths [middle-volume group, odds ratio (OR) 0.62; 95% confidence interval (CI), 0.46-0.83; high-volume group, OR 0.66; 95% CI, 0.45-0.97], more patients were discharged home (middle-volume group, OR 1.29; 95% CI, 1.03-1.62; high-volume group, OR 2.00; 95% CI, 1.48-2.71), and shorter hospital stay (middle-volume group, coefficient -3.30; 95% CI, -6.42 to -0.19; high-volume group, coefficient -4.54; 95% CI, -8.69 to -0.40) compared with the low-volume group. In conclusion, higher rehabilitation units per day provided to patients with aspiration pneumonia were associated with fewer deaths, more home discharges, and shorter hospital stays.
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Affiliation(s)
- Yuki Kato
- Department of Rehabilitation, Mie University Hospital
| | - Shinsuke Hori
- Department of Rehabilitation, Mie University Hospital
| | - Kenta Ushida
- Department of Rehabilitation Medicine, Mie University Graduate School of Medicine, Edobashi Tsu
| | - Miho Shimizu
- Department of Rehabilitation, Mie University Hospital
| | - Yuka Shirai
- Department of Clinical Nutrition Unit, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Ryo Momosaki
- Department of Rehabilitation Medicine, Mie University Graduate School of Medicine, Edobashi Tsu
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10
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Kitsios GD, Nguyen VD, Sayed K, Al-Yousif N, Schaefer C, Shah FA, Bain W, Yang H, Fitch A, Li K, Wang X, Qin S, Gentry H, Zhang Y, Varon J, Arciniegas Rubio A, Englert JA, Baron RM, Lee JS, Methé B, Benos PV, Morris A, McVerry BJ. The upper and lower respiratory tract microbiome in severe aspiration pneumonia. iScience 2023; 26:106832. [PMID: 37250794 PMCID: PMC10212968 DOI: 10.1016/j.isci.2023.106832] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 01/24/2023] [Accepted: 05/03/2023] [Indexed: 05/31/2023] Open
Abstract
Uncertainty persists whether anaerobic bacteria represent important pathogens in aspiration pneumonia. In a nested case-control study of mechanically ventilated patients classified as macro-aspiration pneumonia (MAsP, n = 56), non-macro-aspiration pneumonia (NonMAsP, n = 91), and uninfected controls (n = 11), we profiled upper (URT) and lower respiratory tract (LRT) microbiota with bacterial 16S rRNA gene sequencing, measured plasma host-response biomarkers, analyzed bacterial communities by diversity and oxygen requirements, and performed unsupervised clustering with Dirichlet Multinomial Models (DMM). MAsP and NonMAsP patients had indistinguishable microbiota profiles by alpha diversity and oxygen requirements with similar host-response profiles and 60-day survival. Unsupervised DMM clusters revealed distinct bacterial clusters in the URT and LRT, with low-diversity clusters enriched for facultative anaerobes and typical pathogens, associated with higher plasma levels of SPD and sCD14 and worse 60-day survival. The predictive inter-patient variability in these bacterial profiles highlights the importance of microbiome study in patient sub-phenotyping and precision medicine approaches for severe pneumonia.
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Affiliation(s)
- Georgios D. Kitsios
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA15213, USA
- University of Pittsburgh School of Medicine, Pittsburgh, PA15213, USA
- Center for Medicine and the Microbiome, University of Pittsburgh, Pittsburgh, PA15213, USA
- Acute Lung Injury Center for Excellence, Department of Medicine, University of Pittsburgh, Pittsburgh, PA15213, USA
| | - Vi D. Nguyen
- University of Pittsburgh School of Medicine, Pittsburgh, PA15213, USA
- University of California Los Angeles, Department of Medicine, Internal Medicine Residency Program, Los Angeles, CA90095, USA
| | - Khaled Sayed
- University of PittsburghDepartment of Computational & Systems Biology, Pittsburgh, PA15213, USA
- Department of Epidemiology, University of Florida, Gainesville, FL32611, USA
| | - Nameer Al-Yousif
- University of Pittsburgh Medical Center Mercy, Department of Medicine, Pittsburgh, PA15219, USA
| | - Caitlin Schaefer
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA15213, USA
- Acute Lung Injury Center for Excellence, Department of Medicine, University of Pittsburgh, Pittsburgh, PA15213, USA
| | - Faraaz A. Shah
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA15213, USA
- University of Pittsburgh School of Medicine, Pittsburgh, PA15213, USA
- Acute Lung Injury Center for Excellence, Department of Medicine, University of Pittsburgh, Pittsburgh, PA15213, USA
- Veteran’s Affairs Pittsburgh Healthcare System, Pittsburgh, PA15240, USA
| | - William Bain
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA15213, USA
- University of Pittsburgh School of Medicine, Pittsburgh, PA15213, USA
- Acute Lung Injury Center for Excellence, Department of Medicine, University of Pittsburgh, Pittsburgh, PA15213, USA
- Veteran’s Affairs Pittsburgh Healthcare System, Pittsburgh, PA15240, USA
| | - Haopu Yang
- University of Pittsburgh School of Medicine, Pittsburgh, PA15213, USA
- School of Medicine, Tsinghua University, Beijing, China
| | - Adam Fitch
- Center for Medicine and the Microbiome, University of Pittsburgh, Pittsburgh, PA15213, USA
| | - Kelvin Li
- Center for Medicine and the Microbiome, University of Pittsburgh, Pittsburgh, PA15213, USA
| | - Xiaohong Wang
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA15213, USA
| | - Shulin Qin
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA15213, USA
- Center for Medicine and the Microbiome, University of Pittsburgh, Pittsburgh, PA15213, USA
| | - Heather Gentry
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA15213, USA
| | - Yingze Zhang
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA15213, USA
- Acute Lung Injury Center for Excellence, Department of Medicine, University of Pittsburgh, Pittsburgh, PA15213, USA
| | - Jack Varon
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA02115, USA
| | - Antonio Arciniegas Rubio
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA02115, USA
| | - Joshua A. Englert
- Division of Pulmonary, Critical Care, and Sleep Medicine, The Ohio State University Wexner Medical Center, Columbus, OH43210, USA
| | - Rebecca M. Baron
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA02115, USA
| | - Janet S. Lee
- Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, St. Louis, MO63110, USA
| | - Barbara Methé
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA15213, USA
- Center for Medicine and the Microbiome, University of Pittsburgh, Pittsburgh, PA15213, USA
| | - Panayiotis V. Benos
- Department of Epidemiology, University of Florida, Gainesville, FL32611, USA
| | - Alison Morris
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA15213, USA
- University of Pittsburgh School of Medicine, Pittsburgh, PA15213, USA
- Center for Medicine and the Microbiome, University of Pittsburgh, Pittsburgh, PA15213, USA
- Department of Immunology, University of Pittsburgh School of Medicine, Pittsburgh, PA15213, USA
| | - Bryan J. McVerry
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA15213, USA
- University of Pittsburgh School of Medicine, Pittsburgh, PA15213, USA
- Center for Medicine and the Microbiome, University of Pittsburgh, Pittsburgh, PA15213, USA
- Acute Lung Injury Center for Excellence, Department of Medicine, University of Pittsburgh, Pittsburgh, PA15213, USA
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11
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Zhang Y, Wang K, Yu H, Zhao T, Lin L, Qin X, Wu T, Chen D, Hu Y, Wu Y. Incidence and characteristics of aspiration pneumonia in adults in Beijing, China, 2011-2017. Public Health 2023; 220:65-71. [PMID: 37270854 DOI: 10.1016/j.puhe.2023.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 04/21/2023] [Accepted: 04/26/2023] [Indexed: 06/06/2023]
Abstract
OBJECTIVES This study aimed to estimate aspiration pneumonia (AP) incidence and describe comorbid characteristics and mortality in Beijing, China. STUDY DESIGN A historical cohort study was conducted based on medical claim records. METHODS Patients admitted with a primary diagnosis of AP were identified from approximately 12 million adults who enrolled in the Urban Employee Basic Medical Insurance program in Beijing, China, from January 2011 to December 2017. The incidences of AP and pneumonia with risk factors for aspiration (PRFA) were estimated by a Poisson distribution. The estimated annual percentage change was reported to represent the average percentage change in incidence per year. Characteristics and 6-month and 1-year all-cause mortality rates for AP and suspected AP patients were described and compared with community-acquired pneumonia (CAP). RESULTS The incidence rates of hospitalized AP and PRFA were 9.4 (95% confidence interval [CI]: 7.6, 11.3) and 102.9 (95% CI: 95.8, 110.3) per 100,000 person-years, respectively. The incidences increased rapidly with age and were stable across the observed years. Patients with AP and PRFA possessed a greater burden of comorbidities than CAP (mean age-adjusted Charlson comorbidity indices for AP: 7.72, PRFA: 7.83, and CAP: 2.84). The 6-month and 1-year all-cause mortality rates for those with AP and PRFA were higher than those for patients with CAP (6-month mortality, AP: 35.2%, PRFA: 21.8%, CAP: 11.1%; 1-year mortality, AP: 42.7%, PRFA: 26.6%, CAP: 13.2%). CONCLUSIONS The incidence of AP and PRFA in Beijing was reported, presenting a full picture of the disease burden. The results provide baseline information for AP prevention.
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Affiliation(s)
- Y Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Health Science Center, 100191, China
| | - K Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Health Science Center, 100191, China
| | - H Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Health Science Center, 100191, China
| | - T Zhao
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Health Science Center, 100191, China
| | - L Lin
- Geriatric Department, Peking University First Hospital, 100034, China
| | - X Qin
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Health Science Center, 100191, China; Key Laboratory of Epidemiology of Major Diseases, Peking University, Ministry of Education, 100191, China
| | - T Wu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Health Science Center, 100191, China; Key Laboratory of Epidemiology of Major Diseases, Peking University, Ministry of Education, 100191, China
| | - D Chen
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Health Science Center, 100191, China; Key Laboratory of Epidemiology of Major Diseases, Peking University, Ministry of Education, 100191, China
| | - Y Hu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Health Science Center, 100191, China; Key Laboratory of Epidemiology of Major Diseases, Peking University, Ministry of Education, 100191, China.
| | - Y Wu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Health Science Center, 100191, China; Key Laboratory of Epidemiology of Major Diseases, Peking University, Ministry of Education, 100191, China.
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12
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Ogura K, Endo M, Hase T, Negami H, Tsuchiya K, Nishiuchi T, Suzuki T, Ogai K, Sanada H, Okamoto S, Sugama J. Potential biomarker proteins for aspiration pneumonia detected by shotgun proteomics using buccal mucosa samples: a cross-sectional case-control study. Clin Proteomics 2023; 20:9. [PMID: 36894881 PMCID: PMC9996945 DOI: 10.1186/s12014-023-09398-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 02/21/2023] [Indexed: 03/11/2023] Open
Abstract
BACKGROUND Aspiration pneumonia (AP), which is a major cause of death in the elderly, does present with typical symptoms in the early stages of onset, thus it is difficult to detect and treat at an early stage. In this study, we identified biomarkers that are useful for the detection of AP and focused on salivary proteins, which may be collected non-invasively. Because expectorating saliva is often difficult for elderly people, we collected salivary proteins from the buccal mucosa. METHODS We collected samples from the buccal mucosa of six patients with AP and six control patients (no AP) in an acute-care hospital. Following protein precipitation using trichloroacetic acid and washing with acetone, the samples were analyzed by liquid chromatography and tandem mass spectrometry (LC-MS/MS). We also determined the levels of cytokines and chemokines in non-precipitated samples from buccal mucosa. RESULTS Comparative quantitative analysis of LC-MS/MS spectra revealed 55 highly (P values < 0.10) abundant proteins with high FDR confidence (q values < 0.01) and high coverage (> 50%) in the AP group compared with the control group. Among the 55 proteins, the protein abundances of four proteins (protein S100-A7A, eukaryotic translation initiation factor 1, Serpin B4, and peptidoglycan recognition protein 1) in the AP group showed a negative correlation with the time post-onset; these proteins are promising AP biomarker candidates. In addition, the abundance of C-reactive protein (CRP) in oral samples was highly correlated with serum CRP levels, suggesting that oral CRP levels may be used as a surrogate to predict serum CRP in AP patients. A multiplex cytokine/chemokine assay revealed that MCP-1 tended to be low, indicating unresponsiveness of MCP-1 and its downstream immune pathways in AP. CONCLUSION Our findings suggest that oral salivary proteins, which are obtained non-invasively, can be utilized for the detection of AP.
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Affiliation(s)
- Kohei Ogura
- Advanced Health Care Science Research Unit, Institute for Frontier Science Initiative, Kanazawa University, 5-11-80 Kodatsuno, Kanazawa, Ishikawa, 9200942, Japan
| | - Maho Endo
- Advanced Health Care Science Research Unit, Institute for Frontier Science Initiative, Kanazawa University, 5-11-80 Kodatsuno, Kanazawa, Ishikawa, 9200942, Japan.,Nursing Department, Fujita Health University Hospital, 1-98 Dengakugakubo, Kutsukake-Cho, Toyoake, Aichi, 4701192, Japan
| | - Takashi Hase
- Department of Oral and Maxillofacial Surgery, Noto General Hospital, 6-4 Fujibashi, Nanao, Ishikawa, 9260816, Japan
| | - Hitomi Negami
- Department of Oral and Maxillofacial Surgery, Noto General Hospital, 6-4 Fujibashi, Nanao, Ishikawa, 9260816, Japan
| | - Kohsuke Tsuchiya
- Division of Immunology and Molecular Biology, Cancer Research Institute, Kanazawa University. Kakuma-Cho, Kanazawa, Ishikawa, 9201164, Japan
| | - Takumi Nishiuchi
- Division of Functional Genomics, Advanced Science Research Center, Kanazawa University, Kanazawa, Ishikawa, 9200934, Japan
| | - Takeshi Suzuki
- Division of Functional Genomics, Cancer Research Institute, Kanazawa University. Kakuma-Cho, Kanazawa, Ishikawa, 9201164, Japan
| | - Kazuhiro Ogai
- Institute of Medical, Pharmaceutical and Health Sciences, AI Hospital/Macro Signal Dynamics Research and Development Center, Kanazawa University, 5-11-80 Kodatsuno, Kanazawa, Ishikawa, 9200942, Japan
| | - Hiromi Sanada
- Ishikawa Prefectural Nursing University, 1-1 Gakuendai, Kahoku, Ishikawa, 929-1210, Japan
| | - Shigefumi Okamoto
- Advanced Health Care Science Research Unit, Institute for Frontier Science Initiative, Kanazawa University, 5-11-80 Kodatsuno, Kanazawa, Ishikawa, 9200942, Japan. .,Department of Clinical Laboratory Sciences, Faculty of Health Sciences, Institute of Medical, Pharmaceutical, and Health Sciences, Kanazawa University, 5-11-80 Kodatsuno, Kanazawa, Ishikawa, 9200942, Japan.
| | - Junko Sugama
- Research Center for Implementation Nursing Science Initiative, Innovation Promotion Division, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-Cho, Toyoake, Aichi, 4701192, Japan
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13
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Okubo R, Hoshi SL, Kondo M. Cost-effectiveness of professional and mechanical oral care for preventing pneumonia in nursing home residents. J Am Geriatr Soc 2023; 71:756-764. [PMID: 36334034 DOI: 10.1111/jgs.18122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 09/28/2022] [Accepted: 10/18/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Pneumonia is common in nursing home residents and is a leading cause of hospitalization and death. Nursing home residents with cerebrovascular diseases and impaired consciousness are at high risk of aspiration pneumonia. Professional and mechanical oral care by dentists and hygienists in addition to daily oral care by caregivers was shown to be effective in preventing pneumonia in nursing home residents. However, professional and mechanical oral care has not been widely provided in Japan, while daily oral care by caregivers has been widely provided as a basic service in nursing homes. This study aimed to evaluate the cost-effectiveness of providing professional and mechanical oral care for preventing pneumonia in nursing home residents. METHODS Using a decision tree and Markov modeling, we conducted a cost-effectiveness analysis from the payer's perspective (social insurers and patients) in Japan. RESULTS The incremental cost-effectiveness ratio for professional and mechanical oral care compared with daily oral care only was calculated as 4,079,313 Japanese yen (¥; 33,994 United States dollars [US$], US$1 = ¥120) per quality-adjusted life year. CONCLUSIONS Using the official value of social willingness to pay for a one-quality-adjusted life year gain in Japan of ¥5 million (US$41,667) as the threshold to judge cost-effectiveness, providing professional and mechanical oral care is cost-effective. Our results suggest professional and mechanical oral care for preventing pneumonia in nursing home residents could be justifiable as efficient use of finite healthcare resources. The results have implications for oral care in nursing homes both in Japan and worldwide.
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Affiliation(s)
- Reiko Okubo
- Department of Health Care Policy and Health Economics, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
- Department of Clinical Laboratory Medicine, University of Tsukuba Hospital, Tsukuba, Ibaraki, Japan
- Department of Nephrology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Shu-Ling Hoshi
- Department of Health Care Policy and Health Economics, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Masahide Kondo
- Department of Health Care Policy and Health Economics, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
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14
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Smithard DG, Yoshimatsu Y. Pneumonia, Aspiration Pneumonia, or Frailty-Associated Pneumonia? Geriatrics (Basel) 2022; 7:115. [PMID: 36286218 PMCID: PMC9602119 DOI: 10.3390/geriatrics7050115] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 10/07/2022] [Accepted: 10/10/2022] [Indexed: 11/17/2022] Open
Abstract
Pneumonia is a common reason for admission afflicting frail older adults. Those who are the frailest are more likely to be provided with a diagnosis of aspiration pneumonia. This diagnosis has no clear definition and no clinical consensus. It is therefore time to stop attempting to differentiate between pneumonia type and use the term frailty-associated pneumonia.
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Affiliation(s)
- David G. Smithard
- Queen Elizabeth Hospital, Lewisham and Greenwich NHS Trust, London SE19 4QH, UK
- Centre for Exercise, Activity and Rehabilitation, University of Greenwich Southwood Site, London SE9 2UG, UK
| | - Yuki Yoshimatsu
- Queen Elizabeth Hospital, Lewisham and Greenwich NHS Trust, London SE19 4QH, UK
- Centre for Exercise, Activity and Rehabilitation, University of Greenwich Southwood Site, London SE9 2UG, UK
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15
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Yoshimatsu Y, Melgaard D, Westergren A, Skrubbeltrang C, Smithard DG. The diagnosis of aspiration pneumonia in older persons: a systematic review. Eur Geriatr Med 2022; 13:1071-1080. [PMID: 36008745 PMCID: PMC9409622 DOI: 10.1007/s41999-022-00689-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 08/09/2022] [Indexed: 01/15/2023]
Abstract
PURPOSE Community-acquired pneumonia (CAP) is highly common across the world. It is reported that over 90% of CAP in older adults may be due to aspiration. However, the diagnostic criteria for aspiration pneumonia (AP) have not been widely agreed. Is there a consensus on how to diagnose AP? What are the clinical features of patients being diagnosed with AP? We conducted a systematic review to answer these questions. METHODS We performed a literature search in MEDLINE®, EMBASE, CINHAL, and Cochrane to review the steps taken toward diagnosing AP. Search terms for "aspiration pneumonia" and "aged" were used. Inclusion criteria were: original research, community-acquired AP, age ≥ 75 years old, acute hospital admission. RESULTS A total of 10,716 reports were found. Following the removal of duplicates, 7601 were screened, 95 underwent full-text review, and 9 reports were included in the final analysis. Pneumonia was diagnosed using a combination of symptoms, inflammatory markers, and chest imaging findings in most studies. AP was defined as pneumonia with some relation to aspiration or dysphagia. Aspiration was inferred if there was witnessed or prior presumed aspiration, episodes of coughing on food or liquids, relevant underlying conditions, abnormalities on videofluoroscopy or water swallow test, and gravity-dependent distribution of shadows on chest imaging. Patients with AP were older, more frailer, and had more comorbidities than in non-AP. CONCLUSION There is a broad consensus on the clinical criteria to diagnose AP. It is a presumptive diagnosis with regards to patients' general frailty rather than in relation to swallowing function itself.
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Affiliation(s)
- Yuki Yoshimatsu
- Elderly Care, Queen Elizabeth Hospital, Lewisham and Greenwich NHS Trust, Stadium Rd, London, SE18 4QH, UK.
- Centre for Exercise Activity and Rehabilitation, School of Human Sciences, University of Greenwich, London, UK.
| | - Dorte Melgaard
- Centre for Clinical Research, North Denmark Regional Hospital, Hjoerring, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Albert Westergren
- The Research Platform for Collaboration for Health, Faculty of Health Sciences, Kristianstad University, Kristianstad, Sweden
| | | | - David G Smithard
- Elderly Care, Queen Elizabeth Hospital, Lewisham and Greenwich NHS Trust, Stadium Rd, London, SE18 4QH, UK
- Centre for Exercise Activity and Rehabilitation, School of Human Sciences, University of Greenwich, London, UK
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16
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Lever TE, Kloepper AM, Deninger I, Hamad A, Hopewell BL, Ovaitt AK, Szewczyk M, Bunyak F, Zitsch B, Blake B, Vandell C, Dooley L. Advancing Laryngeal Adductor Reflex Testing Beyond Sensory Threshold Detection. Dysphagia 2021; 37:1151-1171. [PMID: 34686917 DOI: 10.1007/s00455-021-10374-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 09/27/2021] [Indexed: 11/25/2022]
Abstract
Flexible endoscopic evaluation of swallowing with sensory testing (FEESST) is a promising clinical tool to assess airway integrity via the laryngeal adductor reflex (LAR). The current clinical protocol relies on sensory threshold detection, as relatively little is known about the motor response of this sensorimotor airway protective reflex. Here, we focused on characterizing normative LAR motion dynamics in 20 healthy young participants using our prototype high-pressure syringe-based air pulse device and analytic software (VFtrack™) that tracks vocal fold (VF) motion in endoscopic videos. Following device bench testing for air pulse stimulus characterization, we evoked and objectively quantified LAR motion dynamics in response to two suprathreshold air pulse stimuli (40 versus 60 mm Hg), delivered to the arytenoid mucosa through a bronchoscope working channel. The higher air pressures generated by our device permitted an approximate 1 cm endoscope working distance for continual visualization of the bilateral VFs throughout the LAR. Post hoc video analysis identified two main findings: (1) there are variant and invariant subcomponents of the LAR motor response, and (2) only a fraction of suprathreshold stimuli evoked complete glottic closure during the LAR. While the clinical relevance of these findings remains to be determined, we have nonetheless demonstrated untapped potential in the current FEESST protocol. Our ongoing efforts may reveal LAR biomarkers to quantify the severity of laryngeal pathology and change over time with natural disease progression, spontaneous recovery, or in response to intervention. The ultimate goal is to facilitate predictive modeling of patients at high risk for dysphagia-related aspiration pneumonia.
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Affiliation(s)
- Teresa E Lever
- Department of Otolaryngology - Head and Neck Surgery, University of Missouri School of Medicine, One Hospital Dr. MA314, Columbia, MO, 65212, USA.
| | - Ashley M Kloepper
- Department of Otolaryngology - Head and Neck Surgery, University of Missouri School of Medicine, One Hospital Dr. MA314, Columbia, MO, 65212, USA
| | - Ian Deninger
- Department of Otolaryngology - Head and Neck Surgery, University of Missouri School of Medicine, One Hospital Dr. MA314, Columbia, MO, 65212, USA
| | - Ali Hamad
- Electrical Engineering and Computer Science, University of Missouri, Columbia, MO, USA
| | - Bridget L Hopewell
- Department of Otolaryngology - Head and Neck Surgery, University of Missouri School of Medicine, One Hospital Dr. MA314, Columbia, MO, 65212, USA
| | - Alyssa K Ovaitt
- Department of Otolaryngology - Head and Neck Surgery, University of Missouri School of Medicine, One Hospital Dr. MA314, Columbia, MO, 65212, USA
| | - Marlena Szewczyk
- Department of Otolaryngology - Head and Neck Surgery, University of Missouri School of Medicine, One Hospital Dr. MA314, Columbia, MO, 65212, USA
| | - Filiz Bunyak
- Electrical Engineering and Computer Science, University of Missouri, Columbia, MO, USA
| | - Bradford Zitsch
- Department of Otolaryngology - Head and Neck Surgery, University of Missouri School of Medicine, One Hospital Dr. MA314, Columbia, MO, 65212, USA
| | - Brett Blake
- Department of Otolaryngology - Head and Neck Surgery, University of Missouri School of Medicine, One Hospital Dr. MA314, Columbia, MO, 65212, USA
| | - Caitlin Vandell
- Department of Otolaryngology - Head and Neck Surgery, University of Missouri School of Medicine, One Hospital Dr. MA314, Columbia, MO, 65212, USA
| | - Laura Dooley
- Department of Otolaryngology - Head and Neck Surgery, University of Missouri School of Medicine, One Hospital Dr. MA314, Columbia, MO, 65212, USA
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17
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Suzuki J, Ikeda R, Kato K, Kakuta R, Kobayashi Y, Ohkoshi A, Ishii R, Hirano-Kawamoto A, Ohta J, Kawata R, Kanbayashi T, Hatano M, Shishido T, Miyakura Y, Ishigaki K, Yamauchi Y, Nakazumi M, Endo T, Tozuka H, Kitaya S, Numano Y, Koizumi S, Saito Y, Unuma M, Hashimoto K, Ishida E, Kikuchi T, Kudo T, Watanabe K, Ogura M, Tateda M, Sasaki T, Ohta N, Okazaki T, Katori Y. Characteristics of aspiration pneumonia patients in acute care hospitals: A multicenter, retrospective survey in Northern Japan. PLoS One 2021; 16:e0254261. [PMID: 34329339 PMCID: PMC8323917 DOI: 10.1371/journal.pone.0254261] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 06/23/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Pneumonia is a common cause of illness and death of the elderly in Japan. Its prevalence is escalating globally with the aging of population. To describe the latest trends in pneumonia hospitalizations, especially aspiration pneumonia (AP) cases, we assessed the clinical records of pneumonia patients admitted to core acute care hospitals in Miyagi prefecture, Japan. METHODS A retrospective multi-institutional joint research was conducted for hospitalized pneumonia patients aged ≥20 years from January 2019 to December 2019. Clinical data of patients were collected from the medical records of eight acute care hospitals. RESULTS Out of the 1,800 patients included in this study, 79% of the hospitalized pneumonia patients were aged above 70 years. The most common age group was in the 80s. The ratio of AP to total pneumonia cases increased with age, and 692 out of 1,800 patients had AP. In univariate analysis, these patients had significantly older ages, lower body mass index (BMI), a lower ratio of normal diet intake and homestay before hospitalization, along with more AP recurrences and comorbidities. During hospitalization, AP patients had extended fasting periods, more swallowing assessments and interventions, longer hospitalization, and higher in-hospital mortality rate than non-AP patients. A total of 7% and 2% AP patients underwent video endoscopy and video fluorography respectively. In multivariate analysis, lower BMI, lower C-reactive protein, a lower ratio of homestay before hospitalization, a higher complication rate of cerebrovascular disease, dementia, and neuromuscular disease were noted as a characteristic of AP patients. Swallowing interventions were performed for 51% of the AP patients who had been hospitalized for more than two weeks. In univariate analysis, swallowing intervention improved in-hospital mortality. Lower AP recurrence before hospitalization and a lower ratio of homestay before hospitalization were indicated as characteristics of AP patients of the swallowing intervention group from multivariate analysis. Change in dietary pattern from normal to modified diet was observed more frequently in the swallowing intervention group. CONCLUSION AP accounts for 38.4% of all pneumonia cases in acute care hospitals in Northern Japan. The use of swallowing evaluations and interventions, which may reduce the risk of dysphagia and may associate with lowering mortality in AP patients, is still not widespread.
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Affiliation(s)
- Jun Suzuki
- Department of Otolaryngology and Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Ryoukichi Ikeda
- Department of Otolaryngology and Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
- * E-mail:
| | - Kengo Kato
- Department of Otolaryngology and Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Risako Kakuta
- Department of Otolaryngology and Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yuta Kobayashi
- Department of Otolaryngology and Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Akira Ohkoshi
- Department of Otolaryngology and Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Ryo Ishii
- Department of Otolaryngology and Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Ai Hirano-Kawamoto
- Department of Otolaryngology and Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Jun Ohta
- Department of Otolaryngology and Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Rei Kawata
- Division of Otolaryngology, Tohoku Medical and Pharmaceutical University Hospital, Sendai, Japan
| | - Tomonori Kanbayashi
- Department of Otolaryngology and Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Masaki Hatano
- Department of Otolaryngology and Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Tadahisa Shishido
- Department of Otolaryngology and Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yuya Miyakura
- Department of Otolaryngology, South Miyagi Medical Center, Ogawara, Japan
| | - Kento Ishigaki
- Department of Otolaryngology, Tohoku Rosai Hospital, Sendai, Japan
| | | | - Miho Nakazumi
- Department of Otolaryngology, Osaki Citizen Hospital, Osaki, Japan
| | - Takuya Endo
- Department of Otolaryngology, Japanese Red Cross Ishinomaki Hospital, Ishinomaki, Japan
| | - Hiroki Tozuka
- Department of Otolaryngology, Sendai Medical center, Sendai, Japan
| | - Shiori Kitaya
- Division of Otolaryngology, Tohoku Medical and Pharmaceutical University Hospital, Sendai, Japan
| | - Yuki Numano
- Department of Otolaryngology, Osaki Citizen Hospital, Osaki, Japan
| | - Shotaro Koizumi
- Department of Otolaryngology, Tohoku Rosai Hospital, Sendai, Japan
| | - Yutaro Saito
- Division of Otolaryngology, Tohoku Medical and Pharmaceutical University Hospital, Sendai, Japan
| | - Mutsuki Unuma
- Department of Otolaryngology, Tohoku Rosai Hospital, Sendai, Japan
| | - Ken Hashimoto
- Department of Otolaryngology, Japanese Red Cross Ishinomaki Hospital, Ishinomaki, Japan
| | - Eiichi Ishida
- Department of Otolaryngology, Sendai Medical center, Sendai, Japan
| | - Toshiaki Kikuchi
- Department of Otolaryngology, Sendai Medical center, Sendai, Japan
| | - Takayuki Kudo
- Department of Otolaryngology, South Miyagi Medical Center, Ogawara, Japan
| | - Kenichi Watanabe
- Department of Otolaryngology, Tohoku Rosai Hospital, Sendai, Japan
| | - Masaki Ogura
- Department of Otolaryngology, Sendai City Hospital, Sendai, Japan
| | - Masaru Tateda
- Department of Otolaryngology, Sendai Medical center, Sendai, Japan
| | - Takatsuna Sasaki
- Department of Otolaryngology, Osaki Citizen Hospital, Osaki, Japan
| | - Nobuo Ohta
- Division of Otolaryngology, Tohoku Medical and Pharmaceutical University Hospital, Sendai, Japan
| | - Tatsuma Okazaki
- Department of Physical Medicine and Rehabilitation, Tohoku University graduate School of Medicine, Sendai, Japan
| | - Yukio Katori
- Department of Otolaryngology and Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
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18
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Hirooka N, Nakayama T, Kobayashi T, Nakamoto H. Predictive Value of the Pneumonia Severity Score on Mortality due to Aspiration Pneumonia. Clin Med Res 2021; 19:47-53. [PMID: 33547167 PMCID: PMC8231691 DOI: 10.3121/cmr.2020.1560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 11/16/2020] [Accepted: 12/09/2020] [Indexed: 11/18/2022]
Abstract
Objective: Designing an efficient management strategy for aspiration is of high priority in our aging society because of its high incidence. We evaluated the prognostic value of both the A-DROP (age, dehydration, respiratory, disorientation, and pressure) and the modified A-DROP scoring systems (adding respiratory rate and comorbidity to A-DROP) in patients with aspiration pneumonia.Design: This is a retrospective study using electronic medical records at Saitama Medical University (SMU) hospital.Setting: A 965-bed university tertiary medical center in Japan.Participants: Data were extracted from the electronic medical records of patients from SMU hospital.Methods: In-hospital mortality was compared between two groups: (1) those with a 'severe' to 'advanced severe' A-DROP score; and (2) those with a 'low' to 'middle' A-DROP score. Area under the curve (AUC) for mortality for both the A-DROP and modified A-DROP scoring systems were compared.Results: The in-hospital mortality rates for patients with a high and a low A-DROP score were 28.6% and 9.0%, respectively. The mortality rates in the high modified A-DROP score group and in the low modified A-DROP score group were 28.2% and 9.9%, respectively. These differences in the mortality rates between the two groups were statistically significant for both the A-DROP and the modified A-DROP scoring systems. The AUC of the receiver operating characteristics curve for the A-DROP (0.700; 95% confidence interval, 0.608-0.779) was statistically significant.Conclusion: The A-DROP and modified A-DROP scoring systems are associated with in-hospital mortality in patients with aspiration pneumonia. The A-DROP scoring system is easy to use and may be a clinically valuable tool in the management of aspiration pneumonia.
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Affiliation(s)
- Nobutaka Hirooka
- Department of General Internal Medicine, Saitama Medical University, Morohongo 38, Moroyama-chou, Iruma-gun, Saitama, Japan 350-0495
| | - Tomohiro Nakayama
- Department of General Internal Medicine, Saitama Medical University, Morohongo 38, Moroyama-chou, Iruma-gun, Saitama, Japan 350-0495
| | - Takehito Kobayashi
- Department of General Internal Medicine, Saitama Medical University, Morohongo 38, Moroyama-chou, Iruma-gun, Saitama, Japan 350-0495
| | - Hidetomo Nakamoto
- Department of General Internal Medicine, Saitama Medical University, Morohongo 38, Moroyama-chou, Iruma-gun, Saitama, Japan 350-0495
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19
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Almirall J, Boixeda R, de la Torre MC, Torres A. Aspiration pneumonia: A renewed perspective and practical approach. Respir Med 2021; 185:106485. [PMID: 34087609 DOI: 10.1016/j.rmed.2021.106485] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 05/22/2021] [Accepted: 05/24/2021] [Indexed: 11/27/2022]
Abstract
Aspiration pneumonia (AP) is a sub-type of community-acquired pneumonia (CAP) still poorly recognized especially in the absence of an aspiration event. A further difficulty is the differentiation between AP and aspiration pneumonitis. From a clinical perspective, AP is becoming increasingly relevant as a potential cause of severe and life-threatening respiratory infection among frail and very old patients, particularly among those with CAP requiring inpatient care. Moreover, AP is frequently underdiagnosed and a clear-cut definition of this pathological entity is lacking. There are different factors that increase the risk for aspiration, but other common factors influencing oral colonization such as malnutrition, smoking, poor oral hygiene or dry mouth, are also important in the pathogenesis of AP and should be considered. While there is no doubt in the diagnosis of AP in cases of a recent witnessed aspiration of oropharyngeal or gastric content, we here proposed a definition of AP that also includes silent unobserved aspirations. For this reason, the presence of one or more risk factors of oropharyngeal aspiration is required together with one or more risk factors for oral bacterial colonization. This proposed definition based on expert opinion not only unifies the diagnostic criteria of AP, but also provides the possibility to devise easily applicable strategies to prevent oral colonization.
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Affiliation(s)
- Jordi Almirall
- Intensive Care Unit, Hospital de Mataró, Universitat Autònoma de Barcelona, Consorci Sanitari Del Maresme, Mataró, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain.
| | - Ramon Boixeda
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain; Service of Internal Medicine, Hospital de Mataró, Consorci Sanitari Del Maresme, Mataró, Barcelona, Spain; Universitat de Barcelona, Barcelona, Spain.
| | - Mari C de la Torre
- Intensive Care Unit, Hospital de Mataró, Universitat Autònoma de Barcelona, Consorci Sanitari Del Maresme, Mataró, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain.
| | - Antoni Torres
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain; Universitat de Barcelona, Barcelona, Spain; Service of Pneumology, Institut Clínic Del Torax, Institut D'Investigació Biomédica Agustí Pi I Sunyer (IDIBAPS), Hospital Clínic de Barcelona, Barcelona, Spain.
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20
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Mehta A, Martin T, Demiralp B, Steele-Adjognon M, Agarwal A, Mahadev S, Sharaiha RZ. National Health Burden of Aspiration Pneumonia on Clinical and Operational Outcomes in Patients With Small Bowel Obstruction Requiring Nasogastric Decompression. Am Surg 2020; 87:1074-1079. [PMID: 33307723 DOI: 10.1177/0003134820960049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Nasogastric tubes (NGTs) are used for decompression in patients with acute small bowel obstruction (SBO); however, their role remains controversial. There is evidence that NGT use is still associated with high incidence of aspiration pneumonia. The aims of this study were to define the prevalence of aspiration pneumonia in patients with SBO managed with an NGT and estimate the association of aspiration pneumonia with 30-day mortality rates, length of stay (LOS), and hospital costs. MATERIALS AND METHODS A retrospective cohort study was done using Medicare Inpatient Standard Analytic Files from 2016 to 2018. Patients hospitalized with SBO and managed with NGT were identified using an algorithm of ICD-10-CM codes. The key exposure was aspiration pneumonia. Outcome measures included 30-day mortality rates, LOS, and hospital costs. RESULTS 53 715 patients hospitalized with SBO and managed with an NGT were identified and included in the analysis. We observed a prevalence of aspiration pneumonia of 7.3%. The 30-day mortality rate was 31% for those who developed aspiration pneumonia vs. 10% for those without pneumonia (P < .001). Those with aspiration pneumonia, on average, were hospitalized 7.0 days longer (P < .001) and accrued $20,543 greater hospitalization costs (P < .001) than those without pneumonia. Controlling for hospital size and hospital teaching status, we noted a significant association between aspiration pneumonia and increased mortality (P < .001), longer length of stay (P < .001), and higher hospital costs (P < .001). DISCUSSION Among patients hospitalized for SBO who required an NGT, aspiration pneumonia was associated with a higher mortality rate, longer hospital LOS, and higher total hospital costs. vv.
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Affiliation(s)
- Amit Mehta
- Division of Gastroenterology and Hepatology, 159947Weill Cornell Medical Center, NY, USA
| | - Tracey Martin
- Division of Gastroenterology and Hepatology, 159947Weill Cornell Medical Center, NY, USA
| | | | | | | | - Srihari Mahadev
- Division of Gastroenterology and Hepatology, 159947Weill Cornell Medical Center, NY, USA
| | - Reem Z Sharaiha
- Division of Gastroenterology and Hepatology, 159947Weill Cornell Medical Center, NY, USA
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21
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Bolinger C, Dembowski J, Mory K. Pneumonia: Does Age or Gender Relate to the Presence of an SLP Dysphagia Consultation? Geriatrics (Basel) 2020; 5:geriatrics5030051. [PMID: 32937853 PMCID: PMC7554969 DOI: 10.3390/geriatrics5030051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 09/06/2020] [Accepted: 09/07/2020] [Indexed: 12/12/2022] Open
Abstract
A retrospective study of 1489 hospital records examined the relationship of speech-language pathologist (SLP) consults for dysphagia to age and gender in pneumonia patients from an acute care setting. Age and gender disparities exist in healthcare. The research sought to determine if disparities existed in the presence/absence of SLP dysphagia consults related to age and gender. Results suggested SLPs were consulted on a greater percentage of geriatric patients overall; however, there were differences in the number of consults for each pneumonia type. More males and geriatric patients were seen than females and non-geriatric adults, respectively. Results may be used to address local hospital policies and protocols and thus increase quality of care by improving morbidity and mortality outcomes of geriatric patients with pneumonia.
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Affiliation(s)
- Christopher Bolinger
- Department of Communication Sciences and Oral Health, College of Health Sciences, Texas Woman’s University, Denton, TX 76207, USA;
- Correspondence: ; Tel.: +1-940-898-2001
| | - James Dembowski
- Department of Speech, Language, and Hearing Sciences, School of Health Professions, Texas Tech Health Sciences Center, Lubbock, TX 79430, USA;
| | - Kimberly Mory
- Department of Communication Sciences and Oral Health, College of Health Sciences, Texas Woman’s University, Denton, TX 76207, USA;
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22
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Marin-Corral J, Pascual-Guardia S, Amati F, Aliberti S, Masclans JR, Soni N, Rodriguez A, Sibila O, Sanz F, Sotgiu G, Anzueto A, Dimakou K, Petrino R, van de Garde E, Restrepo MI. Aspiration Risk Factors, Microbiology, and Empiric Antibiotics for Patients Hospitalized With Community-Acquired Pneumonia. Chest 2020; 159:58-72. [PMID: 32687909 DOI: 10.1016/j.chest.2020.06.079] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 06/18/2020] [Accepted: 06/22/2020] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Aspiration community-acquired pneumonia (ACAP) and community-acquired pneumonia (CAP) in patients with aspiration risk factors (AspRFs) are infections associated with anaerobes, but limited evidence suggests their pathogenic role. RESEARCH QUESTION What are the aspiration risk factors, microbiology patterns, and empiric anti-anaerobic use in patients hospitalized with CAP? STUDY DESIGN AND METHODS This is a secondary analysis of GLIMP, an international, multicenter, point-prevalence study of adults hospitalized with CAP. Patients were stratified into three groups: (1) ACAP, (2) CAP/AspRF+ (CAP with AspRF), and (3) CAP/AspRF- (CAP without AspRF). Data on demographics, comorbidities, microbiological results, and anti-anaerobic antibiotics were analyzed in all groups. Patients were further stratified in severe and nonsevere CAP groups. RESULTS We enrolled 2,606 patients with CAP, of which 193 (7.4%) had ACAP. Risk factors independently associated with ACAP were male, bedridden, underweight, a nursing home resident, and having a history of stroke, dementia, mental illness, and enteral tube feeding. Among non-ACAP patients, 1,709 (70.8%) had CAP/AspRF+ and 704 (29.2%) had CAP/AspRF-. Microbiology patterns including anaerobes were similar between CAP/AspRF-, CAP/AspRF+ and ACAP (0.0% vs 1.03% vs 1.64%). Patients with severe ACAP had higher rates of total gram-negative bacteria (64.3% vs 44.3% vs 33.3%, P = .021) and lower rates of total gram-positive bacteria (7.1% vs 38.1% vs 50.0%, P < .001) when compared with patients with severe CAP/AspRF+ and severe CAP/AspRF-, respectively. Most patients (>50% in all groups) independent of AspRFs or ACAP received specific or broad-spectrum anti-anaerobic coverage antibiotics. INTERPRETATION Hospitalized patients with ACAP or CAP/AspRF+ had similar anaerobic flora compared with patients without aspiration risk factors. Gram-negative bacteria were more prevalent in patients with severe ACAP. Despite having similar microbiological flora between groups, a large proportion of CAP patients received anti-anaerobic antibiotic coverage.
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Affiliation(s)
- Judith Marin-Corral
- Critical Care Department, Hospital del Mar, Barcelona, Spain, and the Critical Illness Research Group (GREPAC), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain; Division of Pulmonary Diseases & Critical Care Medicine, University of Texas Health San Antonio, San Antonio, TX
| | - Sergi Pascual-Guardia
- Division of Pulmonary Diseases & Critical Care Medicine, University of Texas Health San Antonio, San Antonio, TX; Respiratory Department, Hospital del Mar, IMIM, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Spain
| | - Francesco Amati
- Fondazione IRCCS Ca Granda Ospedale Maggiore Policlinico, Respiratory Unit and Cystic Fibrosis Adult Center, and University of Milan, Department of Pathophysiology and Transplantation, Milan, Italy
| | - Stefano Aliberti
- Fondazione IRCCS Ca Granda Ospedale Maggiore Policlinico, Respiratory Unit and Cystic Fibrosis Adult Center, and University of Milan, Department of Pathophysiology and Transplantation, Milan, Italy
| | - Joan R Masclans
- Critical Care Department, Hospital del Mar, Barcelona, Spain, and the Critical Illness Research Group (GREPAC), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain; Department of Medicine, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Nilam Soni
- Division of Pulmonary Diseases & Critical Care Medicine, University of Texas Health San Antonio, San Antonio, TX; Section of Pulmonary & Critical Care Medicine, South Texas Veterans Health Care System, San Antonio, TX
| | - Alejandro Rodriguez
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Spain; Critical Care Medicine, Hospital Universitari Joan XXIII and Rovira & Virgili University, Tarragona, Spain
| | - Oriol Sibila
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Spain; Department of Pulmonary Medicine, Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and University of Barcelona, Barcelona, Spain
| | - Francisco Sanz
- Pulmonology Department, Consorci Hospital General Universitari de Valencia, Valencia, Spain
| | - Giovanni Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Antonio Anzueto
- Division of Pulmonary Diseases & Critical Care Medicine, University of Texas Health San Antonio, San Antonio, TX; Section of Pulmonary & Critical Care Medicine, South Texas Veterans Health Care System, San Antonio, TX
| | - Katerina Dimakou
- 5th Department of Pulmonary Medicine, Sotiria Chest Diseases Hospital, Athens, Greece
| | | | - Ewoudt van de Garde
- Department of Clinical Pharmacy, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Marcos I Restrepo
- Division of Pulmonary Diseases & Critical Care Medicine, University of Texas Health San Antonio, San Antonio, TX; Section of Pulmonary & Critical Care Medicine, South Texas Veterans Health Care System, San Antonio, TX.
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Thomson J, Hall M, Ambroggio L, Berry JG, Stone B, Srivastava R, Shah SS. Antibiotics for Aspiration Pneumonia in Neurologically Impaired Children. J Hosp Med 2020; 15:395-402. [PMID: 31891564 PMCID: PMC7641495 DOI: 10.12788/jhm.3338] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To compare hospital outcomes associated with commonly used antibiotic therapies for aspiration pneumonia in children with neurologic impairment (NI). DESIGN/METHODS A retrospective study of children with NI hospitalized with aspiration pneumonia at 39 children's hospitals in the Pediatric Health Information System database. Exposure was empiric antibiotic therapy classified by antimicrobial activity. Outcomes included acute respiratory failure, intensive care unit (ICU) transfer, and hospital length of stay (LOS). Multivariable regression evaluated associations between exposure and outcomes and adjusted for confounders, including medical complexity and acute illness severity. RESULTS In the adjusted analysis, children receiving Gram-negative coverage alone had two-fold greater odds of respiratory failure (odds ratio [OR] 2.15; 95% CI: 1.41-3.27), greater odds of ICU transfer (OR 1.80; 95% CI: 1.03-3.14), and longer LOS [adjusted rate ratio (RR) 1.28; 95% CI: 1.16-1.41] than those receiving anaerobic coverage alone. Children receiving anaerobic and Gram-negative coverage had higher odds of respiratory failure (OR 1.65; 95% CI: 1.19-2.28) than those receiving anaerobic coverage alone, but ICU transfer (OR 1.15; 95% CI: 0.73-1.80) and length of stay (RR 1.07; 95% CI: 0.98-1.16) did not statistically differ. For children receiving anaerobic, Gram-negative, and P. aeruginosa coverage, LOS was shorter (RR 0.83; 95% CI: 0.76-0.90) than those receiving anaerobic coverage alone; odds of respiratory failure and ICU transfer rates did not significantly differ. CONCLUSIONS Anaerobic therapy appears to be important in the treatment of aspiration pneumonia in children with NI. While Gram-negative coverage alone was associated with worse outcomes, its addition to anaerobic therapy may not yield improved outcomes.
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Affiliation(s)
- Joanna Thomson
- Division of Hospital Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Corresponding Author: Joanna Thomson, MD, MPH; ; Telephone: 513-636-0257
| | - Matt Hall
- Children’s Hospital Association, Lenexa, Kansas
| | - Lilliam Ambroggio
- Sections of Emergency Medicine and Hospital Medicine, Children’s Hospital Colorado, Department of Pediatrics, University of Colorado
| | - Jay G Berry
- Division of General Pediatrics, Children’s Hospital Boston, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Bryan Stone
- Division of Inpatient Medicine, Primary Children’s Hospital, Intermountain Health Care, Salt Lake City, Utah
- Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | - Rajendu Srivastava
- Division of Inpatient Medicine, Primary Children’s Hospital, Intermountain Health Care, Salt Lake City, Utah
- Institute for Health-care Delivery Research, Intermountain Healthcare, Salt Lake City, Utah
| | - Samir S Shah
- Division of Hospital Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Division of Infectious Diseases, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
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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: 32] [Impact Index Per Article: 8.0] [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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Giroux I, Pauzé E, Rosa M. [Apprentissage par simulation : activité novatrice de formation interprofessionnelle sur la gestion de la dysphagie]. CAN J DIET PRACT RES 2020; 81:44-48. [PMID: 31081679 DOI: 10.3148/cjdpr-2019-016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Interprofessional patient simulations are an emerging pedagogical approach that is increasingly being used in the education of health professionals. Although the benefits of patient simulations have been widely documented in the fields of medicine and nursing, few studies have explored the potential of this approach in educating future dietitians. This article describes 4 patient simulations, including 2 interprofessional simulations, focused on the management of dysphagia, which were carried out as part of an Honours Bachelor in Nutrition Sciences program and discusses the potential merits of this teaching method in educating future dietitians.
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Affiliation(s)
- Isabelle Giroux
- Écoles des sciences de la nutrition, Université d'Ottawa, Ottawa, ON
| | - Elise Pauzé
- Écoles des sciences de la nutrition, Université d'Ottawa, Ottawa, ON
| | - Mylène Rosa
- Faculté d'éducation, Université d'Ottawa, Ottawa, ON
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26
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Oi I, Ito I, Tanabe N, Konishi S, Hamao N, Yasutomo Y, Kadowaki S, Hirai T. Cefepime vs. meropenem for moderate-to-severe pneumonia in patients at risk for aspiration: An open-label, randomized study. J Infect Chemother 2020; 26:181-187. [DOI: 10.1016/j.jiac.2019.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 07/16/2019] [Accepted: 08/07/2019] [Indexed: 10/26/2022]
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Zakharenkov IA, Rachina SA, Dekhnich NN, Kozlov RS, Sinopalnikov AI, Ivanchik NV, Yatsyshina SB, Elkina MA, Archipenko MV, Gordeeva SA, Lebedeva MS, Portnyagina US. [Etiology of severe community - acquired pneumonia in adults: results of the first Russian multicenter study]. TERAPEVT ARKH 2020; 92:36-42. [PMID: 32598661 DOI: 10.26442/00403660.2020.01.000491] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Indexed: 11/22/2022]
Abstract
AIM to study the etiology of severe community - acquired pneumonia (SCAP) in adults in Russian Federation. SCAP is distinguished by high mortality and socio - economic burden. Both etiology and antimicrobial resistance are essential for appropriate antibiotic choice. MATERIALS AND METHODS A prospective cohort study recruited adults with confirmed diagnosis of SCAP admitted to multi - word hospitals of six Russian cities in 2014-2018. Etiology was confirmed by routine culture of blood, respiratory (sputum, endotracheal aspirate or bronchoalveolar lavage) and when appropriate, autopsy samples, urinary antigen tests (L. pneumophila serogroup 1, S. pneumoniae); real - time PCR for identification of "atypical" bacterial pathogens (M. pneumoniae, C. pneumoniae, L. pneumophila) and respiratory viruses (influenza viruses A and B, parainfluenza, human metapneumovirus, etc.) was applied. RESULTS Altogether 109 patients (60.6% male; mean age 50.8±18.0 years old) with SCAP were enrolled. Etiological agent was identified in 65.1% of patients, S. pneumoniae, rhinovirus, S. aureus and K. pneumoniae were the most commonly isolated pathogens (found in 43.7, 15.5, 14.1 and 11.3% of patients with positive results of microbiological investigations, respectively). Bacteriemia was seen in 14.6% of patients and most commonly associated with S. pneumoniae. Co - infection with 2 or more causative agents was revealed in 36.6% of cases. Combination of bacterial pathogens (mainly S. pneumoniae with S. aureus or/and Enterobacterales) prevailed - 57.7% of cases; associations of bacteria and viruses were identified in 38.5% of patients, different viruses - in one case. CONCLUSION S. pneumoniae was the most common pathogen in adults with SCAP. A high rate of respiratory viruses (mainly rhinovirus and influenza viruses) identification both as mixt infection with bacteria and mono - infection should be taken into account.
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Affiliation(s)
- I A Zakharenkov
- Bryansk city hospital №1.,The Interregional Association for Clinical Microbiology and Antimicrobial Chemotherapy
| | | | | | - R S Kozlov
- The Interregional Association for Clinical Microbiology and Antimicrobial Chemotherapy.,Smolensk State Medical University
| | | | | | | | - M A Elkina
- Central Research Institute of Epidemiology
| | | | - S A Gordeeva
- P.A. Bayandin Murmansk State Regional Clinical Hospital
| | - M S Lebedeva
- State Budgetary Healthcare Institution «Saint-Petersburg clinical scientific and practical center for specialised types of medical care (oncological)»
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Variation in the Diagnosis of Aspiration Pneumonia and Association with Hospital Pneumonia Outcomes. Ann Am Thorac Soc 2019; 15:562-569. [PMID: 29298090 DOI: 10.1513/annalsats.201709-728oc] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
RATIONALE National efforts to compare hospital outcomes for patients with pneumonia may be biased by hospital differences in diagnosis and coding of aspiration pneumonia, a condition that has traditionally been excluded from pneumonia outcome measures. OBJECTIVES To evaluate the rationale and impact of including patients with aspiration pneumonia in hospital mortality and readmission measures. METHODS Using Medicare fee-for-service claims for patients 65 years and older from July 2012 to June 2015, we characterized the proportion of hospitals' patients with pneumonia diagnosed with aspiration pneumonia, calculated hospital-specific risk-standardized rates of 30-day mortality and readmission for patients with pneumonia, analyzed the association between aspiration pneumonia coding frequency and these rates, and recalculated these rates including patients with aspiration pneumonia. RESULTS A total of 1,101,892 patients from 4,263 hospitals were included in the mortality measure analysis, including 192,814 with aspiration pneumonia. The median proportion of hospitals' patients with pneumonia diagnosed with aspiration pneumonia was 13.6% (10th-90th percentile, 4.2-26%). Hospitals with a higher proportion of patients with aspiration pneumonia had lower risk-standardized mortality rates in the traditional pneumonia measure (12.0% in the lowest coding and 11.0% in the highest coding quintiles) and were far more likely to be categorized as performing better than the national mortality rate; expanding the measure to include patients with aspiration pneumonia attenuated the association between aspiration pneumonia coding rate and hospital mortality. These findings were less pronounced for hospital readmission rates. CONCLUSIONS Expanding the pneumonia cohorts to include patients with a principal diagnosis of aspiration pneumonia can overcome bias related to variation in hospital coding.
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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: 15] [Impact Index Per Article: 3.0] [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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Ryu AJ, Navin PJ, Hu X, Yi ES, Hartman TE, Ryu JH. Clinico-radiologic Features of Lung Disease Associated With Aspiration Identified on Lung Biopsy. Chest 2019; 156:1160-1166. [PMID: 31398348 DOI: 10.1016/j.chest.2019.07.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 06/10/2019] [Accepted: 07/20/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Aspiration-related lung diseases are commonly diagnosed presumptively based on the clinical context and radiologic findings. Limited data exist on the spectrum of clinico-radiologic presentations associated with aspiration. METHODS This study reviewed all cases of aspiration identified on lung biopsy encountered at the Mayo Clinic between 2003 and 2017. Demographic and clinical features, including risk factors for aspiration, diagnoses suspected prior to biopsy, imaging findings, and microbiologic data, were analyzed. RESULTS A total of 52 consecutive adult cases of aspiration identified on lung biopsy (histologic presence of food or other particulate matter) were included; patients' median age was 59 years (range, 22 to 79 years), 38% were women, and there were five lung transplant recipients. Of these, 63% were diagnosed according to results of surgical biopsy (including four cases of lobectomy) and 37% according to results of transbronchial biopsy. Aspiration was clinically suspected prior to biopsy in 35% of the subjects. Ninety percent of subjects had at least one identifiable risk factor for aspiration; gastroesophageal reflux disease was the most common (62%), followed by a structurally abnormal esophagogastric tract and the use of consciousness-impairing medications. Only 27% of patients reported dysphagia or choking. Chest CT imaging revealed a variety of parenchymal patterns, including bronchiolitis (42%), patchy consolidation (19%), and mass (15%). Of 25 patients undergoing a video-swallow evaluation, 14 (56%) had abnormal results with laryngeal penetration with or without aspiration. Microbial cultures obtained in 21 lung biopsy specimens yielded no pathogens. CONCLUSIONS Aspiration can occur in the absence of subjective or demonstrable swallowing difficulties and manifest a broad spectrum of clinico-radiologic presentations.
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Affiliation(s)
- Alexander J Ryu
- Mayo Clinic School of Graduate Medical Education, Rochester, MN
| | | | - Xiaowen Hu
- Department of Pulmonary and Critical Care Medicine, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Eunhee S Yi
- Division of Anatomic Pathology, Mayo Clinic, Rochester, MN
| | | | - Jay H Ryu
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN.
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Murray A, Mulkerrin S, O’Keeffe ST. The perils of 'risk feeding'. Age Ageing 2019; 48:478-481. [PMID: 30939597 DOI: 10.1093/ageing/afz027] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 03/08/2019] [Indexed: 11/13/2022] Open
Abstract
'Risk feeding' policies, for when people continue to eat and drink despite a perceived risk of choking or aspiration have become common in recent years. We argue that 'feeding' is demeaning language if referring to a person who is eating and drinking rather than to a healthcare technique and that 'risk-anything' is not how decisions are reached. It is true that patients with dysphagia are often unnecessarily designated nil-by-mouth (NBM), especially after a decision has been made that tube feeding is not indicated or is unwanted. However, risk-feeding policies may perpetuate common misperceptions that there is a straightforward relationship between aspiration and pneumonia and that interventions like NBM or tube feeding will reduce the risk of pneumonia. Such policies may reduce the potential for individualised and flexible decision making: many people's swallowing abilities and preferences fluctuate, sometimes from hour to hour, and staff need to have, and be encouraged to use, common sense, flexibility and judgement in these circumstances. There is also the potential for delays in providing food, fluid and medications if meetings must be held and risk-feeding paperwork completed and signed by someone with the necessary seniority and confidence. Further debate and discussion is required before risk-feeding policies become an established standard of care.
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Affiliation(s)
- Aoife Murray
- Department of Geriatric Medicine, Galway University Hospitals, Galway, Ireland
| | - Siofra Mulkerrin
- Department of Speech and Language Therapy, Addenbrooke’s Hospital, Cambridge University Hospitals Trust, Hills Road, Cambridge, UK
| | - Shaun T O’Keeffe
- Department of Geriatric Medicine, Galway University Hospitals, Galway, Ireland
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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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Teh WH, Smith CJ, Barlas RS, Wood AD, Bettencourt-Silva JH, Clark AB, Metcalf AK, Bowles KM, Potter JF, Myint PK. Impact of stroke-associated pneumonia on mortality, length of hospitalization, and functional outcome. Acta Neurol Scand 2018; 138:293-300. [PMID: 29749062 DOI: 10.1111/ane.12956] [Citation(s) in RCA: 88] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2018] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Stroke-associated pneumonia (SAP) is common and associated with adverse outcomes. Data on its impact beyond 1 year are scarce. MATERIALS AND METHODS This observational study was conducted in a cohort of stroke patients admitted consecutively to a tertiary referral center in the east of England, UK (January 2003-April 2015). Logistic regression models examined inpatient mortality and length of stay (LOS). Cox regression models examined longer-term mortality at predefined time periods (0-90 days, 90 days-1 year, 1-3 years, and 3-10 years) for SAP. Effect of SAP on functional outcome at discharge was assessed using logistic regression. RESULTS A total of 9238 patients (mean age [±SD] 77.61 ± 11.88 years) were included. SAP was diagnosed in 1083 (11.7%) patients. The majority of these cases (n = 658; 60.8%) were aspiration pneumonia. After controlling for age, sex, stroke type, Oxfordshire Community Stroke Project (OCSP) classification, prestroke modified Rankin scale, comorbidities, and acute illness markers, mortality estimates remained significant at 3 time periods: inpatient (OR 5.87, 95%CI [4.97-6.93]), 0-90 days (2.17 [1.97-2.40]), and 91-365 days (HR 1.31 [1.03-1.67]). SAP was also associated with higher odds of long LOS (OR 1.93 [1.67-2.22]) and worse functional outcome (OR 7.17 [5.44-9.45]). In this cohort, SAP did not increase mortality risk beyond 1 year post-stroke, but it was associated with reduced mortality beyond 3 years. CONCLUSIONS Stroke-associated pneumonia is not associated with increased long-term mortality, but it is linked with increased mortality up to 1 year, prolonged LOS, and poor functional outcome on discharge. Targeted intervention strategies are required to improve outcomes of SAP patients who survive to hospital discharge.
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Affiliation(s)
- W. H. Teh
- Institute of Applied Health Sciences; School of Medicine; Medical Sciences and Nutrition; University of Aberdeen; Aberdeen UK
| | - C. J. Smith
- Greater Manchester Comprehensive Stroke Centre; Manchester Academic Health Science Centre; Salford Royal NHS Foundation Trust; Salford UK
- Faculty of Biology; Medicine and Health; University of Manchester; Manchester UK
| | - R. S. Barlas
- Institute of Applied Health Sciences; School of Medicine; Medical Sciences and Nutrition; University of Aberdeen; Aberdeen UK
| | - A. D. Wood
- Institute of Applied Health Sciences; School of Medicine; Medical Sciences and Nutrition; University of Aberdeen; Aberdeen UK
| | - J. H. Bettencourt-Silva
- Institute of Applied Health Sciences; School of Medicine; Medical Sciences and Nutrition; University of Aberdeen; Aberdeen UK
- Stroke Research Group; Norwich Cardiovascular Research Group; Norwich Research Park; Norwich UK
| | - A. B. Clark
- Norwich Medical School; University of East Anglia; Norwich UK
| | - A. K. Metcalf
- Stroke Research Group; Norwich Cardiovascular Research Group; Norwich Research Park; Norwich UK
- Stroke Services; Norfolk and Norwich University Hospitals NHS Foundation Trust; Norwich UK
| | - K. M. Bowles
- Norwich Medical School; University of East Anglia; Norwich UK
- Stroke Research Group; Norwich Cardiovascular Research Group; Norwich Research Park; Norwich UK
| | - J. F. Potter
- Norwich Medical School; University of East Anglia; Norwich UK
- Stroke Research Group; Norwich Cardiovascular Research Group; Norwich Research Park; Norwich UK
| | - P. K. Myint
- Institute of Applied Health Sciences; School of Medicine; Medical Sciences and Nutrition; University of Aberdeen; Aberdeen UK
- Stroke Research Group; Norwich Cardiovascular Research Group; Norwich Research Park; Norwich UK
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Arahata M, Asakura H. Antithrombotic therapies for elderly patients: handling problems originating from their comorbidities. Clin Interv Aging 2018; 13:1675-1690. [PMID: 30237704 PMCID: PMC6138962 DOI: 10.2147/cia.s174896] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Compared with younger people, elderly people have higher risks for both thrombosis and bleeding. Furthermore, comorbidities frequently found in elderly patients complicate the management of antithrombotic therapy. Thus, when treating these patients, physicians often find it difficult to incorporate the principles of evidence-based medicine and must determine the best treatment option for each patient. Recently, in the fields of cerebrovascular and cardiovascular diseases, researchers have been rapidly accumulating new data regarding antithrombotic therapy, particularly in the areas of direct oral anticoagulants (DOACs) and dual antiplatelet therapy (DAPT). However, information related to elderly patients receiving antithrombotic therapy is still relatively limited. There are also more and more publications describing how antithrombotic therapy affects the pathogenesis of non-thrombotic diseases. Similarly, the number of reports concerning adherence to this therapy has been increasing lately. However, no review articles detailing these findings have yet been published. In actual clinical practice, antithrombotic therapy in the elderly is not a treatment strategy targeted to only one organ or disease. Rather, it requires an interdisciplinary approach aimed at maintaining the overall health of the patient. Thus, to assist physicians’ decision-making processes for elderly patients, an overview of recent findings related to the evidence regarding concomitant medications, the secondary benefits of antithrombotic therapy for patients with comorbidities, and evidence regarding medication adherence is provided.
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Affiliation(s)
- Masahisa Arahata
- Department of Hematology, Graduate School of Medicine of Kanazawa University, Kanazawa, Ishikawa, Japan,
| | - Hidesaku Asakura
- Department of Hematology, Graduate School of Medicine of Kanazawa University, Kanazawa, Ishikawa, Japan,
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Fujimoto S, Nakayama T. Effect of combination of pre- and postoperative pulmonary rehabilitation on onset of postoperative pneumonia: a retrospective cohort study based on data from the diagnosis procedure combination database in Japan. Int J Clin Oncol 2018; 24:211-221. [PMID: 30145745 DOI: 10.1007/s10147-018-1343-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 08/21/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND To examine the effect of rehabilitation on postoperative pulmonary complication when it is conducted in combination of both before and after lung cancer surgery, as compared with either before or after surgery and no rehabilitation. METHODS A retrospective cohort study was conducted to examine the effect of rehabilitation before and after lung cancer surgery on the causes of postoperative pneumonia. Data were collected from the diagnosis procedure combination (DPC) database. Patients admitted who received operative treatment for a new primary (ICD codes: C34) were selected. The inclusion criteria were patients who had pneumonectomy, malignant tumor surgery for the lung (thoracotomy), or thoracoscopic surgery (endoscopic; treatment code: K511-00, K513-00~03, and K514-00, 02). The exclusion criteria were patients who had a lung transplantation (treatment code: K514-03~06), suspected diagnosis, and a pneumonia within 3 months before being diagnosed as having lung cancer. Main outcome was onset of postoperative pneumonia. RESULTS Among 76,739 lung cancer patients, 15,146 who underwent lung cancer surgery were included in the analysis. In the combination of pre- and postoperative group, as compared with the preoperative [odds ratio (OR), 95% confidence interval (CI) 2.8, 1.8-4.4], postoperative (1.9, 1.6-2.3), and no rehabilitation group (2.5, 2.1-2.8), the onset of pneumonia was less frequent. CONCLUSIONS Combination of preoperative and postoperative rehabilitations significantly prevents postoperative pneumonia as compared with having preoperative, postoperative, or no rehabilitation.
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Affiliation(s)
- Shuhei Fujimoto
- Department of Health Informatics, Graduate School of Public Health, Kyoto University, Yoshidakonoe-cho, Sakyo-ku, Kyoto, Kyoto, 606-8501, Japan.
| | - Takeo Nakayama
- Department of Health Informatics, Graduate School of Public Health, Kyoto University, Yoshidakonoe-cho, Sakyo-ku, Kyoto, Kyoto, 606-8501, Japan
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Abstract
RATIONALE Aspiration pneumonia is a subset of pneumonias prevalent in elderly patients and patients with neurologic disorders. Researchers in previous studies mostly reported incidence and/or mortality rates based on regional data or in specific subgroups of patients. There is a paucity of nationwide data in the contemporary U.S. POPULATION OBJECTIVES To describe U.S. national trends in acute care hospital admission for aspiration pneumonia from 2002 to 2012. METHODS We used the U.S. National (Nationwide) Inpatient Sample database to identify patients admitted with a primary diagnosis of aspiration pneumonia between 2002 and 2012. We estimated trends in the incidence, in-hospital mortality, length of stay, and total hospitalization cost for patients admitted for aspiration pneumonia and stratified on the basis of patient age (≥65 yr vs. <65 yr). Multivariable logistic regression analysis was used to identify independent predictors for in-hospital mortality. RESULTS A total of 406,798 patients (weighted total, 1,741,517) admitted for aspiration pneumonia were included in this study. There were 84,200 (20.7%) patients younger than 65 years of age and 322,598 patients (79.3%) aged 65 years or older. From 2002 to 2012, the overall incidence of aspiration pneumonia decreased from 8.2 to 7.1 cases per 10,000 people, and in-hospital mortality decreased from 18.6 to 9.8%. For patients aged 65 years or older, the incidence decreased from 40.7 to 30.9 cases per 10,000 people, and the in-hospital mortality decreased from 20.7 to 11.3%. The median total hospitalization charges increased in both groups (age ≥65 yr, from $16,173 to $30,280; age <65 yr, from $17,517 to $30,526). In multivariable logistic analysis, patients aged 65 years or older or treatment in a nonteaching hospital were independent predictors of in-hospital mortality. CONCLUSIONS The incidence and mortality of patients admitted to acute care hospitals for aspiration pneumonia decreased between 2002 and 2012 in the United States. This difference was more evident for elderly patients. However, the cost of hospitalization almost doubled. Being older than 65 years of age is an independent predictor of in-hospital mortality among patients admitted for aspiration pneumonia. Strategies to prevent aspiration pneumonia in the community should be implemented in the aging U.S. POPULATION
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Noguchi S, Yatera K, Kato T, Chojin Y, Fujino Y, Akata K, Kawanami T, Sakamoto N, Mukae H. Impact of the number of aspiration risk factors on mortality and recurrence in community-onset pneumonia. Clin Interv Aging 2017; 12:2087-2094. [PMID: 29263657 PMCID: PMC5724415 DOI: 10.2147/cia.s150499] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Introduction The clinical significance of the number of aspiration risk factors in patients with pneumonia is unknown as yet. In the present study, we clarify the significance of the number of aspiration risk factors for mortality and recurrence in pneumonia patients. Methods This study included 322 patients hospitalized with pneumonia between December 2014 and June 2016. We investigated associations between the number of aspiration risk factors present (orientation disturbance, bedridden, chronic cerebrovascular disease, dementia, sleeping medications and gastroesophageal disease) and 30-day and 6-month mortality, and pneumonia recurrence within 30 days. Results Patients were categorized by number of risk factors present into groups of 0–1, 2, 3, and 4 or more. Of a total of 322 patients, 93 (28.9%) had 0–1 risk factors, 112 (34.8%) had 2, 88 (27.3%) had 3, and 29 (9.0%) had 4 or more risk factors. The percentages of patients with recurrence of pneumonia were 13.0%, 33.0%, 43.2%, and 54.2% in the 0–1, 2, 3, and 4 or more risk factor groups, respectively. The percentages of patients with 30-day mortality were 2.2%, 5.4%, 11.4%, and 24.1%, and those of patients with 6-month mortality were 6.6%, 24.5%, 30.7%, and 50.0%, in the 0–1, 2, 3, and 4 or more risk factor groups, respectively. Conclusions The number of aspiration risk factors was associated with increases in both mortality and recurrence in pneumonia patients. Therefore, in clinical practice, physicians should consider not only the presence of aspiration risks but also the number of aspiration risk factors in these patients.
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Affiliation(s)
- Shingo Noguchi
- Department of Respiratory Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Kazuhiro Yatera
- Department of Respiratory Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Tatsuji Kato
- Department of Respiratory Medicine, Tobata Kyoritsu Hospital, Kitakyushu, Japan
| | - Yasuo Chojin
- Department of Respiratory Medicine, Tobata Kyoritsu Hospital, Kitakyushu, Japan
| | - Yoshihisa Fujino
- Department of Preventive Medicine and Community Health, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Kentaro Akata
- Department of Respiratory Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Toshinori Kawanami
- Department of Respiratory Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Noriho Sakamoto
- Department of Respiratory Medicine, Unit of Translational Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Hiroshi Mukae
- Department of Respiratory Medicine, Unit of Translational Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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Kendall KA. Evaluation of airway protection: Quantitative timing measures versus penetration/aspiration score. Laryngoscope 2017; 127:2314-2318. [DOI: 10.1002/lary.26653] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 03/10/2017] [Accepted: 03/31/2017] [Indexed: 02/02/2023]
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Palacios-Ceña D, Hernández-Barrera V, López-de-Andrés A, Fernández-de-Las-Peñas C, Palacios-Ceña M, de Miguel-Díez J, Carrasco-Garrido P, Jiménez-García R. Time trends in incidence and outcomes of hospitalizations for aspiration pneumonia among elderly people in Spain (2003-2013). Eur J Intern Med 2017; 38:61-67. [PMID: 28065660 DOI: 10.1016/j.ejim.2016.12.022] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 12/22/2016] [Accepted: 12/30/2016] [Indexed: 01/22/2023]
Abstract
BACKGROUND Aspiration pneumonia (AP) is an infectious process causing high rates of mortality. The purpose of this study was: 1, to describe the incidence from 2003 to 2013 of AP hospitalizations; 2, to assess time trends in hospital outcomes variables, and; 3, to identify the factors independently associated with in-hospital mortality (IHM). METHODS A retrospective observational study using the Spanish National Hospital Database, with patients discharged between January 2003 and December 2013 was conducted. Inclusion criteria were: Subjects aged 75years or older whose medical diagnosis included AP events code according to the ICD-9-CM: 507.x in the primary diagnosis field. Patient variables, up to 14 discharge diagnoses per patient, and up to 20 procedures performed during the hospital stay (ICD-9-CM), Charlson Comorbidity Index, readmission, length of hospital stay (LOHS), and IHM were analyzed. RESULTS We included 111,319 admissions (53.13% women). LOHS decreased in both sexes (P<0.001) and was significantly higher in men (10.4±10.31 vs. 9.56±10.02days). Readmissions increased significantly in women during the study (13.94% in 2003 to 16.41% in 2013, P<0.001). In both sex, IHM was significantly higher in >94years old subjects (OR: 1.43, 95%CI 1.36-1.51) and in those with readmissions (OR: 1.20, 95%CI 1.15-1.23). For the entire population, time trend analyses showed a significant decrease in mortality from 2003 to 2013 (OR: 0.96, 95%CI 0.95-0.97). CONCLUSIONS Patients with AP are older, male, and have more comorbidities than those without AP. Over time, LOHS and IHM decreased in both sexes, but readmissions increased significantly in women.
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Affiliation(s)
- Domingo Palacios-Ceña
- Department of Physiotherapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain.
| | - Valentín Hernández-Barrera
- Medicine and Surgery, Psychology, Preventive Medicine and Public Health, Medical Microbiology and Immunology and Nursing Department, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain.
| | - Ana López-de-Andrés
- Medicine and Surgery, Psychology, Preventive Medicine and Public Health, Medical Microbiology and Immunology and Nursing Department, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain.
| | - César Fernández-de-Las-Peñas
- Department of Physiotherapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain.
| | - María Palacios-Ceña
- Department of Physiotherapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain.
| | - Javier de Miguel-Díez
- Respiratory Department, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid (UCM), Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain.
| | - Pilar Carrasco-Garrido
- Medicine and Surgery, Psychology, Preventive Medicine and Public Health, Medical Microbiology and Immunology and Nursing Department, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain.
| | - Rodrigo Jiménez-García
- Medicine and Surgery, Psychology, Preventive Medicine and Public Health, Medical Microbiology and Immunology and Nursing Department, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain.
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Komiya K, Rubin BK, Kadota JI, Mukae H, Akaba T, Moro H, Aoki N, Tsukada H, Noguchi S, Shime N, Takahashi O, Kohno S. Prognostic implications of aspiration pneumonia in patients with community acquired pneumonia: A systematic review with meta-analysis. Sci Rep 2016; 6:38097. [PMID: 27924871 PMCID: PMC5141412 DOI: 10.1038/srep38097] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 11/04/2016] [Indexed: 12/18/2022] Open
Abstract
Aspiration pneumonia is thought to be associated with a poor outcome in patients with community acquired pneumonia (CAP). However, there has been no systematic review regarding the impact of aspiration pneumonia on the outcomes in patients with CAP. This review was conducted using the MOOSE guidelines: Patients: patients defined CAP. Exposure: aspiration pneumonia defined as pneumonia in patients who have aspiration risk. Comparison: confirmed pneumonia in patients who were not considered to be at high risk for oral aspiration. Outcomes: mortality, hospital readmission or recurrent pneumonia. Three investigators independently identified published cohort studies from PubMed, CENTRAL database, and EMBASE. Nineteen studies were included for this systematic review. Aspiration pneumonia increased in-hospital mortality (relative risk, 3.62; 95% CI, 2.65–4.96; P < 0.001, seven studies) and 30-day mortality (3.57; 2.18–5.86; P < 0.001, five studies). In contrast, aspiration pneumonia was associated with decreased ICU mortality (relative risk, 0.40; 95% CI, 0.26–0.60; P < 0.00001, four studies). Although there are insufficient data to perform a meta-analysis on long-term mortality, recurrent pneumonia, and hospital readmission, the few reported studies suggest that aspiration pneumonia is also associated with these poor outcomes. In conclusion, aspiration pneumonia was associated with both higher in-hospital and 30-day mortality in patients with CAP outside ICU settings.
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Affiliation(s)
- Kosaku Komiya
- Department of Pediatrics, Virginia Commonwealth University School of Medicine, 1217 East Marshall Street: KMSB, Room 215 Richmond, Virginia 23298, USA.,Respiratory Medicine and Infectious Diseases, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama-machi, Yufu, Oita, 879-5593, Japan.,Clinical Research Center of Respiratory Medicine, Tenshindo Hetsugi Hospital, 5956 Nihongi, Nakahetsugi, Oita, 879-7761, Japan
| | - Bruce K Rubin
- Department of Pediatrics, Virginia Commonwealth University School of Medicine, 1217 East Marshall Street: KMSB, Room 215 Richmond, Virginia 23298, USA
| | - Jun-Ichi Kadota
- Respiratory Medicine and Infectious Diseases, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama-machi, Yufu, Oita, 879-5593, Japan
| | - Hiroshi Mukae
- Second Department of Internal Medicine, Nagasaki University School of Medicine, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Tomohiro Akaba
- Department of Pediatrics, Virginia Commonwealth University School of Medicine, 1217 East Marshall Street: KMSB, Room 215 Richmond, Virginia 23298, USA
| | - Hiroshi Moro
- Department of Respiratory Medicine and Infectious Diseases, Niigata University Graduate School of Medical and Dental Sciences, 757 Asahi-machi, Chuo-ku, Niigata, 951-8510, Japan
| | - Nobumasa Aoki
- Department of Respiratory Medicine and Infectious Diseases, Niigata University Graduate School of Medical and Dental Sciences, 757 Asahi-machi, Chuo-ku, Niigata, 951-8510, Japan
| | - Hiroki Tsukada
- Department of Respiratory Medicine/Infectious Disease, Niigata City General Hospital, 463-7 Shumoku, Chuo-ku, Niigata, 950-1197, Japan
| | - Shingo Noguchi
- Department of Respiratory Medicine, University of Occupational and Environmental Health, 1-1 Idaigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Japan
| | - Nobuaki Shime
- Department of Emergency and Critical Care Medicine, Institute of Biomedical &Health Sciences, Hiroshima University Advanced Emergency and Critical Care Center, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8553, Japan
| | - Osamu Takahashi
- Center for Clinical Epidemiology, St. Luke's Life Science Institute, 10-1 Akashicho, Chuo-ku, Tokyo, 104-0044, Japan
| | - Shigeru Kohno
- Second Department of Internal Medicine, Nagasaki University School of Medicine, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
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Maeda K, Akagi J. Muscle Mass Loss Is a Potential Predictor of 90-Day Mortality in Older Adults with Aspiration Pneumonia. J Am Geriatr Soc 2016; 65:e18-e22. [PMID: 27858956 DOI: 10.1111/jgs.14543] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To investigate the association between loss of muscle mass and aspiration pneumonia (AP). DESIGN Prospective observational cohort. SETTING Acute geriatric hospital. PARTICIPANTS Individuals admitted to the hospital for AP (N = 151; mean age 85.9; 49.7% male). MEASUREMENTS Appendicular skeletal muscle index (ASMI; appendicular skeletal muscle mass divided by height squared) was used to evaluate muscle mass. Data on age, sex, body mass index, Mini Nutritional Assessment-Short Form score, Barthel Index score, Charlson Comorbidity Index score, and pneumonia severity (Japanese version of the CURB-65 (C (confusion), U (blood urea nitrogen ≥20 mg/dL), R (respiratory rate ≥30 breaths/min), B (systolic blood pressure <90 mmHg or diastolic blood pressure ≤60 mmHg), 65 (aged ≥65) severity score (A-DROP)) were obtained. Outcomes included 30- and 90-day mortality. RESULTS Mild, moderate, severe, and extremely severe AP were observed in 1.3%, 70.2%, 25.8%, and 2.6% of participants, respectively. On Kaplan-Meier analysis, participants in the lowest ASMI quartile for each sex were more likely to die than those in the other quartiles (log-lank test P = .005). Multivariate logistic analyses showed that ASMI and A-DROP were independent predictors of 90-day mortality; only A-DROP was a significant predictor of 30-day mortality (P < .001). Cox regression analysis also showed that the first ASMI quartile was independently associated with mortality (hazard ratio = 2.19; 95% confidence interval = 1.06-4.52; P = .03). CONCLUSION Low muscle mass is a potential predictor of long-term mortality in individuals with AP. Prospectively preventing muscle mass deterioration may be beneficial for recovery from AP in older adults.
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Affiliation(s)
- Keisuke Maeda
- Department of Nutrition and Dysphagia Rehabilitation, Tamana Regional Health Medical Center, Kumamoto, Japan
| | - Junji Akagi
- Department of Surgery, Tamana Regional Health Medical Center, Kumamoto, Japan
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Affiliation(s)
- Hans Jürgen Heppner
- Klinik für Geriatrie, HELIOS Klinikum Schwelm, Lehrstuhl Geriatrie Universität Witten/Herdecke, Dr.-Moeller-Str. 15, D-58332, Schwelm, Deutschland.
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44
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Wirth R, Dziewas R, Beck AM, Clavé P, Hamdy S, Heppner HJ, Langmore S, Leischker AH, Martino R, Pluschinski P, Rösler A, Shaker R, Warnecke T, Sieber CC, Volkert D. Oropharyngeal dysphagia in older persons - from pathophysiology to adequate intervention: a review and summary of an international expert meeting. Clin Interv Aging 2016; 11:189-208. [PMID: 26966356 PMCID: PMC4770066 DOI: 10.2147/cia.s97481] [Citation(s) in RCA: 273] [Impact Index Per Article: 34.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Oropharyngeal dysphagia (OD) is a highly prevalent and growing condition in the older population. Although OD may cause very severe complications, it is often not detected, explored, and treated. Older patients are frequently unaware of their swallowing dysfunction which is one of the reasons why the consequences of OD, ie, aspiration, dehydration, and malnutrition, are regularly not attributed to dysphagia. Older patients are particularly vulnerable to dysphagia because multiple age-related changes increase the risk of dysphagia. Physicians in charge of older patients should be aware that malnutrition, dehydration, and pneumonia are frequently caused by (unrecognized) dysphagia. The diagnosis is particularly difficult in the case of silent aspiration. In addition to numerous screening tools, videofluoroscopy was the traditional gold standard of diagnosing OD. Recently, the fiberoptic endoscopic evaluation of swallowing is increasingly utilized because it has several advantages. Besides making a diagnosis, fiberoptic endoscopic evaluation of swallowing is applied to evaluate the effectiveness of therapeutic maneuvers and texture modification of food and liquids. In addition to swallowing training and nutritional interventions, newer rehabilitation approaches of stimulation techniques are showing promise and may significantly impact future treatment strategies.
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Affiliation(s)
- Rainer Wirth
- Department for Internal Medicine and Geriatrics, St Marien-Hospital Borken, Borken, Germany; Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nürnberg, Germany
| | - Rainer Dziewas
- Department of Neurology, University Hospital Münster, Münster, Germany
| | - Anne Marie Beck
- Department of Nutrition and Health, Faculty of Health and Technology, Metropolitan University College, Copenhagen, Denmark
| | - Pere Clavé
- Centro de Investigación Biomédica en Red de enfermadades Hepáticas y Digestivas (CIBERehd), Hospital de Mataró, Universitat Autònoma de Barcelona, Mataró, Spain
| | - Shaheen Hamdy
- Centre for Gastrointestinal Sciences, Institute of Inflammation and Repair, University of Manchester, Salford Royal Hospital, Salford, UK
| | - Hans Juergen Heppner
- Department of Geriatrics, Witten- Herdecke University, Schwelm, Germany; Helios Clinic Schwelm, Schwelm, Germany
| | - Susan Langmore
- Department of Speech, Language and Hearing Sciences, Boston University School of Medicine, Boston, MA, USA
| | | | - Rosemary Martino
- Department of Speech-Language Pathology, University of Toronto, Toronto, Canada
| | - Petra Pluschinski
- Department of Phoniatrics and Pediatric Audiology, University of Marburg, Marburg, Germany
| | - Alexander Rösler
- Department of Geriatrics, Marien Hospital Hamburg, Hamburg, Germany
| | - Reza Shaker
- Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Tobias Warnecke
- Department of Neurology, University Hospital Münster, Münster, Germany
| | - Cornel Christian Sieber
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nürnberg, Germany; Department of General Internal Medicine and Geriatrics, St John of God Hospital Regensburg, Regensburg, Germany
| | - Dorothee Volkert
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nürnberg, Germany
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45
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Thomson J, Hall M, Ambroggio L, Stone B, Srivastava R, Shah SS, Berry JG. Aspiration and Non-Aspiration Pneumonia in Hospitalized Children With Neurologic Impairment. Pediatrics 2016; 137:e20151612. [PMID: 26787045 PMCID: PMC6322541 DOI: 10.1542/peds.2015-1612] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/16/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Children with neurologic impairment (NI) are commonly hospitalized for different types of pneumonia, including aspiration pneumonia. We sought to compare hospital management and outcomes of children with NI diagnosed with aspiration versus nonaspiration pneumonia. METHODS A retrospective study of 27 455 hospitalized children aged 1 to 18 years with NI diagnosed with pneumonia from 2007 to 2012 at 40 children's hospitals in the Pediatric Health Information System database. The primary exposure was pneumonia type, classified as aspiration or nonaspiration. Outcomes were complications (eg, acute respiratory failure) and hospital utilization (eg, length of stay, 30-day readmission). Multivariable regression was used to assess the association between pneumonia type and outcomes, adjusting for NI type, comorbid conditions, and other characteristics. RESULTS In multivariable analysis, the 9.7% of children diagnosed with aspiration pneumonia experienced more complications than children with nonaspiration pneumonia (34.0% vs 15.2%, adjusted odds ratio [aOR] 1.2 (95% confidence interval [CI] 1.1-1.3). Children with aspiration pneumonia had significantly longer length of stay (median 5 vs 3 days; ratio of means 1.2; 95% CI 1.2-1.3); more ICU transfers (4.3% vs 1.5%; aOR 1.4; 95% CI 1.1-1.9); greater hospitalization costs (median $11 594 vs $5162; ratio of means 1.2; 95% CI 1.2-1.3); and more 30-day readmissions (17.4% vs 6.8%; aOR 1.3; 95% CI 1.2-1.5). CONCLUSIONS Hospitalized children with NI diagnosed with aspiration pneumonia have more complications and use more hospital resources than when diagnosed with nonaspiration pneumonia. Additional investigation is needed to understand the reasons for these differences.
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Affiliation(s)
- Joanna Thomson
- Divisions of Hospital Medicine, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio;
| | - Matt Hall
- Children’s Hospital Association, Overland Park, Kansas
| | - Lilliam Ambroggio
- Divisions of Hospital Medicine,,Biostatistics and Epidemiology, and,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Bryan Stone
- Primary Children’s Medical Center, Intermountain Health Care, Salt Lake City, Utah;,Division of Inpatient Medicine, Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | - Rajendu Srivastava
- Primary Children’s Medical Center, Intermountain Health Care, Salt Lake City, Utah;,Division of Inpatient Medicine, Department of Pediatrics, University of Utah, Salt Lake City, Utah;,Institute for Healthcare Delivery Research, Intermountain Healthcare, Salt Lake City, Utah
| | - Samir S. Shah
- Divisions of Hospital Medicine,,Infectious Diseases, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio;,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Jay G. Berry
- Division of General Pediatrics, Children’s Hospital Boston, Boston, Massachusetts; and,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
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46
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Falguera M, Ramírez M. Neumonía adquirida en la comunidad. Rev Clin Esp 2015; 215:458-67. [DOI: 10.1016/j.rce.2015.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 05/30/2015] [Accepted: 06/02/2015] [Indexed: 11/30/2022]
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47
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Falguera M, Ramírez M. Community-acquired pneumonia. Rev Clin Esp 2015. [DOI: 10.1016/j.rceng.2015.08.003] [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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Jain S, Self WH, Wunderink RG, Fakhran S, Balk R, Bramley AM, Reed C, Grijalva CG, Anderson EJ, Courtney DM, Chappell JD, Qi C, Hart EM, Carroll F, Trabue C, Donnelly HK, Williams DJ, Zhu Y, Arnold SR, Ampofo K, Waterer GW, Levine M, Lindstrom S, Winchell JM, Katz JM, Erdman D, Schneider E, Hicks LA, McCullers JA, Pavia AT, Edwards KM, Finelli L. Community-Acquired Pneumonia Requiring Hospitalization among U.S. Adults. N Engl J Med 2015; 373:415-27. [PMID: 26172429 PMCID: PMC4728150 DOI: 10.1056/nejmoa1500245] [Citation(s) in RCA: 1560] [Impact Index Per Article: 173.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Community-acquired pneumonia is a leading infectious cause of hospitalization and death among U.S. adults. Incidence estimates of pneumonia confirmed radiographically and with the use of current laboratory diagnostic tests are needed. METHODS We conducted active population-based surveillance for community-acquired pneumonia requiring hospitalization among adults 18 years of age or older in five hospitals in Chicago and Nashville. Patients with recent hospitalization or severe immunosuppression were excluded. Blood, urine, and respiratory specimens were systematically collected for culture, serologic testing, antigen detection, and molecular diagnostic testing. Study radiologists independently reviewed chest radiographs. We calculated population-based incidence rates of community-acquired pneumonia requiring hospitalization according to age and pathogen. RESULTS From January 2010 through June 2012, we enrolled 2488 of 3634 eligible adults (68%). Among 2320 adults with radiographic evidence of pneumonia (93%), the median age of the patients was 57 years (interquartile range, 46 to 71); 498 patients (21%) required intensive care, and 52 (2%) died. Among 2259 patients who had radiographic evidence of pneumonia and specimens available for both bacterial and viral testing, a pathogen was detected in 853 (38%): one or more viruses in 530 (23%), bacteria in 247 (11%), bacterial and viral pathogens in 59 (3%), and a fungal or mycobacterial pathogen in 17 (1%). The most common pathogens were human rhinovirus (in 9% of patients), influenza virus (in 6%), and Streptococcus pneumoniae (in 5%). The annual incidence of pneumonia was 24.8 cases (95% confidence interval, 23.5 to 26.1) per 10,000 adults, with the highest rates among adults 65 to 79 years of age (63.0 cases per 10,000 adults) and those 80 years of age or older (164.3 cases per 10,000 adults). For each pathogen, the incidence increased with age. CONCLUSIONS The incidence of community-acquired pneumonia requiring hospitalization was highest among the oldest adults. Despite current diagnostic tests, no pathogen was detected in the majority of patients. Respiratory viruses were detected more frequently than bacteria. (Funded by the Influenza Division of the National Center for Immunizations and Respiratory Diseases.).
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Affiliation(s)
- Seema Jain
- From the Centers for Disease Control and Prevention, Atlanta (S.J., A.M.B., C.R., M.L., S.L., J.M.W., J.M.K., D.E., E.S., L.A.H., L.F.); Vanderbilt University School of Medicine (W.H.S., C.G.G., J.D.C., F.C., D.J.W., Y.Z., K.M.E.) and University of Tennessee Health Science Center-Saint Thomas Health (C.T.), Nashville, and Le Bonheur Children's Hospital (S.R.A., J.A.M.), University of Tennessee Health Science Center (S.R.A., J.A.M.), and St. Jude Children's Research Hospital (J.A.M.), Memphis - all in Tennessee; Northwestern University Feinberg School of Medicine (R.G.W., E.J.A., D.M.C., C.Q., E.M.H., H.K.D., G.W.W.), John H. Stroger, Jr., Hospital of Cook County (S.F.), and Rush University Medical Center (R.B.) - all in Chicago; University of Utah Health Sciences Center, Salt Lake City (K.A., A.T.P.); and University of Western Australia, Perth (G.W.W.)
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