1
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Lee EY, Xu L, Liszewski MC, Foust AM, Williams-Weekes T, Winant AJ. Respiratory Distress in Children: Review and Update of Imaging Assessment. Semin Roentgenol 2024; 59:267-277. [PMID: 38997181 DOI: 10.1053/j.ro.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 03/03/2024] [Indexed: 07/14/2024]
Affiliation(s)
- Edward Y Lee
- Department of Radiology, Boston Children's Hospital, Boston, MA.
| | - Limin Xu
- Greensboro Radiology, Greensboro, NC
| | - Mark C Liszewski
- Department of Radiology, Columbia University Irving Medical Center, New York, NY
| | - Alexandra M Foust
- Department of Radiology, Monroe Carell Jr Children's Hospital at Vanderbilt and Vanderbilt University Medical Center, Nashville, TN
| | | | - Abbey J Winant
- Department of Radiology, Boston Children's Hospital, Boston, MA
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2
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Abstract
Approximately 5% of children experience difficulty with the complex coordination of sucking, swallowing and breathing required for feeding. Infants with craniofacial malformations may have anatomic and neurologic contributions to feeding problems. Examples include cleft lip and/or palate, micrognathia, maxillary hypoplasia, and pharyngeal dysfunction. Interventions may facilitate weight gain and avoid failure-to-thrive in these infants. An interdisciplinary approach to address feeding challenges in children with craniofacial differences is necessary. Positional changes, latching maneuvers, specialized feeder nipples, squeezable bottles, and cup feeding can be implemented early. Surgical intervention, including gastrostomy tube placement, tongue lip adhesion, mandibular distraction osteogenesis and tracheostomy, may be required in more severe cases.
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Affiliation(s)
- Mark A Green
- Instructor of Oral and Maxillofacial Surgery, Harvard School of Dental Medicine and Harvard Medical School, Oral and Maxillofacial Surgeon, Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Cory M Resnick
- Harvard School of Dental Medicine and Harvard Medical School, Oral and Maxillofacial Surgeon, Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA, USA.
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3
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Abstract
Nosocomial pneumonia, one of the most common hos pital-acquired infectious diseases, is associated with sub stantial morbidity and mortality, approaching 50% in selected patients. Patients with alterations in their tracheobronchial tree or natural host-defense mecha nisms are at increased risk of developing pneumonia. Organisms gain access to the normally sterile tracheo bronchial tree primarily by aspiration of colonized oro pharyngeal gastric secretions. Risk factors for bacterial colonization and the development of nosocomial pneu monia include increased age, elevated pH of gastric con tents, postoperative state, nutritional status, severe underlying disease (for example, chronic obstructive pulmonary disease), administration of corticosteroids or other immunosuppressive therapy, and intubation or mechanical ventilation. High gastric volume may also increase the chance of aspiration of secretions in some high-risk patients.
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Affiliation(s)
- Layne O. Gentry
- Infectious Disease Section, St Luke's Episcopal Hospital,
and the Departments of Microbiology and Immunology, Baylor College of Medicine,
Houston, TX
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4
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Hoyt J. Analytic Reviews : Aspiration Pneumonitis: Patient Risk Factors, Prevention, and Management. J Intensive Care Med 2016. [DOI: 10.1177/0885066690005001s02] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Occurrence of aspiration pneumonitis, the morbid con dition that often follows aspiration of gastric contents, has been documented for over 40 years. A number of risk factors that predispose patients to acid aspiration have been identified. The acidity of the gastric fluid and the volume of the aspirate are high-risk factors that de termine the severity of the pneumonitis. In this review I discuss those conditions that predispose patients to as piration and subsequent development of pneumonitis as well as current strategies for prevention and treatment.
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5
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Malandraki GA, Markaki V, Georgopoulos VC, Bauer JL, Kalogeropoulos I, Nanas S. An international pilot study of asynchronous teleconsultation for oropharyngeal dysphagia. J Telemed Telecare 2013; 19:75-9. [DOI: 10.1177/1357633x12474963] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We investigated whether an expert's consultation provided via telemedicine could improve the quality of care for patients with dysphagia. A trained clinician completed videofluoroscopic swallowing studies (VFSS) of 17 consecutive patients in a Greek hospital. The videofluoroscopic images were then stored on a website for independent review by an expert Speech and Language Pathologist in the US. An extra Rater evaluated 20% of all data for additional reliability testing. Eight diagnostic indicators of swallowing impairment and an overall subjective severity index were recorded for each study. Clinicians were also asked to choose from ten common treatment options for patients with dysphagia. There was good inter-rater agreement for most of the diagnostic indicators examined (ranging from 78% to 90%; kappa = 0.52-0.71) between all three Raters. Agreement on overall severity ratings was exact for more than half of the patients and within one-point on the 4-point scale for all other patients except one. However, the quality of care would have been substandard for more than half of the patients if teleconsultation had not been employed. In settings where a swallowing expert is not available and real-time telemedicine is not feasible, the use of asynchronous teleconsultation can produce better quality of care for patients with dysphagia.
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Affiliation(s)
- Georgia A Malandraki
- Program of Speech and Language Pathology, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, USA
- Step-down Intensive Care Unit, University Hospital Evangelismos, Athens, Greece
| | - Vasiliki Markaki
- Step-down Intensive Care Unit, University Hospital Evangelismos, Athens, Greece
| | - Voula C Georgopoulos
- Department of Speech and Language Therapy, Technological Educational Institute of Patras, Greece
| | - Jaime L Bauer
- Hamilton Plaza Nursing and Rehabilitation Center, New Jersey, USA
| | | | - Serafim Nanas
- Athens Medical School, National and Kapodistrian University of Athens, Greece and Evangelismos Hospital, Athens, Greece
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6
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Weir K, McMahon S, Chang AB. Restriction of oral intake of water for aspiration lung disease in children. Cochrane Database Syst Rev 2012; 2012:CD005303. [PMID: 22972084 PMCID: PMC7389607 DOI: 10.1002/14651858.cd005303.pub3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Primary aspiration of food and fluid is commonly seen in children with feeding and swallowing difficulties associated with a range of diseases and complex medical conditions. Respiratory sequelae and pneumonia are known to be associated with primary aspiration of ingested material, however causality between primary aspiration of specific food and fluid types and pulmonary effects in children is yet to be established in controlled trials. The relative pulmonary morbidity of aspiration of ingested food and fluid materials versus other causes of respiratory disease such as viral and bacterial causes, secondary aspiration of gastrointestinal contents and predisposing lung conditions such as chronic neonatal lung disease in a developing immune system is also unclear. Current management decisions for children who aspirate have to optimise oral nutrition and hydration, while reducing the risk of aspiration to preserve pulmonary integrity. This generally includes restricting aspirated food or fluids and providing texture-modified diets and thickened fluids. Young children frequently refuse thickened fluids providing a management dilemma for both families and health professionals. OBJECTIVES Our objective was to evaluate the efficacy of restriction of oral water ingestion on the pulmonary status of children with thin fluid aspiration demonstrated on a modified barium swallow study. SEARCH METHODS The Cochrane Central Register of Controlled Trials (CENTRAL), the Cochrane Airways Collaborative Review Group Specialised Register, MEDLINE, EMBASE and CINAHL databases were searched by the Cochrane Airways Group. The latest search was performed in May 2102. SELECTION CRITERIA All randomised controlled trials comparing restriction of oral intake of water with unlimited oral water ingestion were eligible to be included. DATA COLLECTION AND ANALYSIS Results of searches were reviewed against a pre-determined criteria for inclusion. No eligible trials were identified for a paediatric population and thus no data were available for analysis. One trial in an adult population was identified and reported. MAIN RESULTS No randomised controlled trials examining the efficacy of restriction of oral intake of water in the management of children with thin fluid aspiration were found. In a single study in an adult population with stroke, no significant differences were seen between a control group of oral water restriction and the experimental group of unlimited oral water ingestion on outcomes such as pneumonia, total oral fluid intake and dehydration. AUTHORS' CONCLUSIONS There are no trials that have adequately evaluated the pulmonary effects of allowing or restricting oral water ingestion in children known to have primary aspiration of thin fluids. Thus, there is currently an absence of evidence to support a strict approach of full restriction of oral intake of water or support a more liberal approach of allowing oral water ingestion in children with primary aspiration of thin fluids.
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Affiliation(s)
- Kelly Weir
- Paediatrics and Child Health, University of Queensland, Herston, Queensland, Australia.
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7
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Malandraki GA, McCullough G, He X, McWeeny E, Perlman AL. Teledynamic evaluation of oropharyngeal swallowing. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2011; 54:1497-505. [PMID: 22052284 PMCID: PMC4165336 DOI: 10.1044/1092-4388(2011/10-0284)] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
PURPOSE The objective of the present investigation was to test the feasibility and clinical utility of a real-time Internet-based protocol for remote, telefluoroscopic evaluation of oropharyngeal swallowing. METHOD In this prospective cohort study, the authors evaluated 32 patients with a primary diagnosis of stroke or head/neck cancer. All patients participated in 2 separate fluoroscopic swallowing evaluations--one traditional on site and one telefluoroscopic off site--through the use of a telemedicine system. Agreement between sites was tested for 3 categories of variables: (a) overall severity of swallowing difficulty, (b) presence and extent of laryngeal penetration and aspiration as rated by the 8-point Penetration-Aspiration scale, and (c) treatment recommendations. RESULTS Results showed overall good agreement in subjective severity ratings (κ = 0.636) and in Penetration-Aspiration scale ratings (mean absolute difference = 1.1 points) between the onsite and offsite clinicians. Agreement in treatment recommendations was moderate to high, ranging from 69.3% to 100%. CONCLUSIONS The present study supports the feasibility and clinical utility of a telemedicine system for evaluating oropharyngeal swallowing. Given the difficulty and expertise needed to complete such evaluations, this study offers promising clinical avenues for patients in rural, remote, and underserved communities and countries where expert swallowing specialists are not available.
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Affiliation(s)
- GA Malandraki
- Department of Biobehavioral Sciences, Program of Speech and Language Pathology, Teachers College, Columbia University, New York
- Department of Speech and Hearing Science, University of Illinois, Urbana-Champaign
- Corresponding Author Address and Contact Information: Adrienne L Perlman, PhD, University of Illinois at Urbana-Champaign, Department of Speech and Hearing Science, 901 South Sixth St., Champaign, IL 61820,
| | - G McCullough
- Department of Speech Language Pathology, University of Central Arkansas, Conway
| | - X He
- Department of Statistics, University of Illinois, Urbana-Champaign
| | - E McWeeny
- Department of Audiology and Speech Pathology, University of Arkansas at Little Rock and University of Arkansas for Medical Sciences
| | - AL Perlman
- Department of Speech and Hearing Science, University of Illinois, Urbana-Champaign
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8
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Management of oropharyngeal dysphagia in the neurologically intact and developmentally normal child. Curr Opin Otolaryngol Head Neck Surg 2010; 18:554-63. [DOI: 10.1097/moo.0b013e32834029de] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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9
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Weir K, McMahon S, Chang AB. Restriction of oral intake of water for aspiration lung disease in children. Cochrane Database Syst Rev 2005:CD005303. [PMID: 16235398 DOI: 10.1002/14651858.cd005303.pub2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Primary aspiration of food and fluid is commonly seen in children with feeding and swallowing difficulties associated with a range of diseases and complex medical conditions. Respiratory sequelae and pneumonia are known to be associated with primary aspiration of ingested material, however causality between primary aspiration of specific food and fluid types and pulmonary effects in children is yet to be established in controlled trials. The relative pulmonary morbidity of aspiration of ingested food and fluid materials versus other causes of respiratory disease such as viral and bacterial causes, secondary aspiration of gastrointestinal contents and predisposing lung conditions such as chronic neonatal lung disease in a developing immune system is also unclear. Current management decisions for children who aspirate have to optimise oral nutrition and hydration, while reducing the risk of aspiration to preserve pulmonary integrity. This generally includes restricting aspirated food or fluids and providing texture-modified diets and thickened fluids. Young children frequently refuse thickened fluids providing a management dilemma for both families and health professionals. OBJECTIVES Our objective was to evaluate the efficacy of restriction of oral water ingestion on the pulmonary status of children with thin fluid aspiration demonstrated on a modified barium swallow study. SEARCH STRATEGY The Cochrane Central Register of Controlled Trials (CENTRAL), the Cochrane Airways Collaborative Review Group Specialised Register, MEDLINE, EMBASE and CINAHL databases were searched by the Cochrane Airways Group. The latest search was performed in January 2005. SELECTION CRITERIA All randomised controlled trials comparing restriction of oral intake of water with unlimited oral water ingestion were eligible to be included. DATA COLLECTION AND ANALYSIS Results of searches were reviewed against a pre-determined criteria for inclusion. No eligible trials were identified for a paediatric population and thus no data were available for analysis. One trial in an adult population was identified and reported. MAIN RESULTS No randomised controlled trials examining the efficacy of restriction of oral intake of water in the management of children with thin fluid aspiration were found. In a single study in an adult population with stroke, no significant differences were seen between a control group of oral water restriction and the experimental group of unlimited oral water ingestion on outcomes such as pneumonia, total oral fluid intake and dehydration. AUTHORS' CONCLUSIONS There are no trials that have adequately evaluated the pulmonary effects of allowing or restricting oral water ingestion in children known to have primary aspiration of thin fluids. Thus, there is currently an absence of evidence to support a strict approach of full restriction of oral intake of water or support a more liberal approach of allowing oral water ingestion in children with primary aspiration of thin fluids.
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Affiliation(s)
- K Weir
- University of Queensland, Paediatrics and Child Health, Herston, Queensland, Australia.
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10
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Prevalence of Silent Gastroesophageal Reflux in Association with Recurrent Lower Respiratory Tract Infections. Clin Nucl Med 2003. [DOI: 10.1097/01.rlu.0000067507.64126.5e] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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11
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Irwin RS, Boulet LP, Cloutier MM, Fuller R, Gold PM, Hoffstein V, Ing AJ, McCool FD, O'Byrne P, Poe RH, Prakash UB, Pratter MR, Rubin BK. Managing cough as a defense mechanism and as a symptom. A consensus panel report of the American College of Chest Physicians. Chest 1998; 114:133S-181S. [PMID: 9725800 DOI: 10.1378/chest.114.2_supplement.133s] [Citation(s) in RCA: 367] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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12
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Abstract
Gastroesophageal reflux is a common pediatric complaint and a frequent reason for pediatric patients to be referred to a gastroenterologist. The pathophysiology and clinical manifestations of this disorder differ according to patient age. The diagnosis is suggested by the history and can be confirmed by a pH probe. In the appropriate clinical setting, anatomic obstruction may need to be ruled out by contrast study. Endoscopy is used to assess associated complications, including esophagitis, esophageal strictures, Barrett's transformation, and failure to thrive. Other complications are controversial, including pulmonary disease, apnea, and sudden infant death syndrome. Treatment depends on the severity of disease. Conservative therapy includes behavorial modifications, prokinetic agents, and H2 antagonists. Proton pump inhibitors are generally reserved for refractory esophagitis. Surgical treatment may be necessary for gastroesophageal reflux resistant to medical management or for severe complications. Gastroesophageal reflux beyond infancy tends to be chronic; therefore, lifelong behavioral modifications or repeated courses of medical therapy may be necessary. An algorithm for the suggested diagnostic approach to gastroesophageal reflux is presented herein.
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Affiliation(s)
- W A Faubion
- Section of Pediatric Gastroenterology, Mayo Clinic Rochester, Minnesota 55905, USA
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13
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Abstract
Pulmonary aspiration of gastric contents can cause a spectrum of sequelae that spans from relatively minor to rapidly lethal disease. To emphasize the extent of this spectrum and to encompass both noninfectious complications and infection, we use the term “aspiration-induced pulmonary injury” rather than “aspiration pneumonia.” In this article we review the relevant literature, focusing on more recent insights into the pathogenesis of lung injury, the natural history of aspiration, risk factors, the relationship between aspiration and infection, and recommendations for management. The relevance to human disease of studies using intra-airway acid instillation in animals is questioned. We discuss the difficulties in predicting the clinical course after aspiration. We identify risk factors for aspiration-induced pulmonary injury that are commonly encountered in the intensive care unit, and discuss in detail factors of special interest to the intensivist, including the impact of tracheal intubation; the effects of enteric intubation, particularly the comparison between pre- and postpyloric routes of enteric feeding administration; and the relative risks associated with particular feeding protocols. We conclude with recommendations regarding treatment and prevention strategies.
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Affiliation(s)
- Judith E. Nelson
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mount Sinai School of Medicine, New York, NY
| | - Marvin Lesser
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mount Sinai School of Medicine, New York, NY
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14
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Vikari CA, Farhood VW, Logue MP. Obstructive atelectasis associated with nasotracheal intubation: a case report. J Oral Maxillofac Surg 1997; 55:992-6. [PMID: 9294512 DOI: 10.1016/s0278-2391(97)90076-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- C A Vikari
- Alameda County Medical Center (Highland Campus), Oakland, CA, USA
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15
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Abstract
The development and use of an 8-point, equal-appearing interval scale to describe penetration and aspiration events are described. Scores are determined primarily by the depth to which material passes in the airway and by whether or not material entering the airway is expelled. Intra- and interjudge reliability have been established. Clinical and scientific uses of the scale are discussed.
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Affiliation(s)
- J C Rosenbek
- Department of Neurology, William S. Middleton Memorial Veterans Hospital, University of Wisconsin School of Medicine, Madison, USA
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16
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17
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Affiliation(s)
- F R Miller
- Department of Otolaryngology and Communicative Disorders, Cleveland Clinic Foundation, OH 44195
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18
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Lykens MG, Bowton DL. Aspiration and acute lung injury. Int J Obstet Anesth 1993; 2:236-40. [PMID: 15636897 DOI: 10.1016/0959-289x(93)90053-k] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aspiration is a common clinical entity whose consequences range from the relatively benign to fulminant acute respiratory failure and death. Clinical situations in which airway protection is lost or compromised predispose patients to aspiration. Treatment of aspiration, while generally supportive, depends in part upon the material aspirated and the resulting clinical syndrome. When mechanical ventilatory support is required, the avoidance of iatrogenic complications, including worsening lung injury, becomes especially important. Preventative measures, either to minimize the chances of aspiration, or to reduce the potential for injury consequent to aspiration may be highly effective in reducing the incidence of aspiration syndromes.
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Affiliation(s)
- M G Lykens
- Department of Medicine, The Bowman Gray School of Medicine of Wake Forest University, Winston-Salem, NC, USA
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19
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Bleach NR. The gag reflex and aspiration: a retrospective analysis of 120 patients assessed by videofluoroscopy. Clin Otolaryngol 1993; 18:303-7. [PMID: 8877191 DOI: 10.1111/j.1365-2273.1993.tb00853.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
An absent gag reflex is often employed clinically as an indicator of aspiration risk. Dysphagia clinic records of 120 neurological patients who had undergone speech therapy and ENT assessment, followed by videofluoroscopy, were retrospectively analysed to ascertain if any link between an absent gag reflex and aspiration could be demonstrated. No association between an absent gag reflex and aspiration or laryngeal overspill was found (Mann-Whitney U-test; 2-tailed P = 0.11). Abnormalities on indirect laryngoscopy were seen in 34/120 patients (28%), and these were more closely related to aspiration risk (Mann-Whitney U-test: 2-tailed P = 0.06). An absent gag reflex is not a useful predictor of aspiration, and assessment of the gag reflex should not be relied upon to predict airway safety. However, indirect laryngoscopy is a useful adjunct to standard speech therapy assessment of the dysphagic patient.
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Affiliation(s)
- N R Bleach
- Department of ENT Surgery, Charing Cross Hospital, London, UK
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21
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Abstract
Swallowing is a brief but intricate process. When this process is interrupted, as in patients with neurologic disorders, problems such as aspiration and risk of malnutrition can occur. The authors of this article discuss an individualized approach to evaluation and management of neurogenic oropharyngeal dysphagia. Three cases illustrate the diversity of causes, signs and symptoms, and clinical course.
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Affiliation(s)
- J Horner
- Department of Surgery, Duke University Medical Center, Durham, NC 27710
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22
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Weisberger EC. Treatment of intractable aspiration using a laryngeal stent or obturator. Ann Otol Rhinol Laryngol 1991; 100:101-7. [PMID: 1992895 DOI: 10.1177/000348949110000204] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Twenty-five patients were treated with a laryngeal stent for potentially reversible chronic aspiration of life-threatening magnitude. The causes of the intractable aspiration were diverse and included chronic neurologic disease, extensive head and neck surgery, and severe gastroesophageal reflux. The advantages of this technique are noted in comparison to those of more invasive procedures. Disadvantages of the laryngeal stent and complications encountered are also covered. The long-term results show that all but one patient had a significant improvement in their chronic aspiration with the stent in place. However, only eight patients achieved adequate oral deglutition without aspiration following stent removal.
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Affiliation(s)
- E C Weisberger
- Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis 46202-5230
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