1
|
Pan D, Chung S, Nielsen E, Niederman MS. Aspiration Pneumonia. Semin Respir Crit Care Med 2024; 45:237-245. [PMID: 38211629 DOI: 10.1055/s-0043-1777772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Abstract
Aspiration pneumonia is a lower respiratory tract infection that results from inhalation of foreign material, often gastric and oropharyngeal contents. It is important to distinguish this from a similar entity, aspiration with chemical pneumonitis, as treatment approaches may differ. An evolving understanding of the human microbiome has shed light on the pathogenesis of aspiration pneumonia, suggesting that dysbiosis, repetitive injury, and inflammatory responses play a role in its development. Risk factors for aspiration events involve a complex interplay of anatomical and physiological dysfunctions in the nervous, gastrointestinal, and pulmonary systems. Current treatment strategies have shifted away from anaerobic organisms as leading pathogens. Prevention of aspiration pneumonia primarily involves addressing oropharyngeal dysphagia, a significant risk factor for aspiration pneumonia, particularly among elderly individuals and those with cognitive and neurodegenerative disorders.
Collapse
Affiliation(s)
- Di Pan
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Samuel Chung
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Erik Nielsen
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Michael S Niederman
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Weill Cornell Medical College, New York, New York
| |
Collapse
|
2
|
Kanzawa Y, Seto H, Shimokawa T, Tsutsumi T, Ishimaru N, Kinami S, Imanaka Y. Clinical decision-making using an assessment protocol of swallowing function after aspiration pneumonia: a comparative retrospective study. J Rural Med 2023; 18:62-69. [PMID: 37032988 PMCID: PMC10079470 DOI: 10.2185/jrm.2022-038] [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: 07/28/2022] [Accepted: 11/11/2022] [Indexed: 04/11/2023] Open
Abstract
Objective: Aspiration pneumonia is a challenge in Japan, with many elderly citizens; however, there are insufficient experts on swallowing. Non-expert doctors may suspend oral intake for an overly long period because of the fear of further aspiration. We devised and modified an assessment protocol for swallowing function with reference to the Japanese and American practical guidelines for dysphagia. This study aimed to demonstrate clinical decision-making using the protocol by reporting the results of decisions on the safe and timely restart of adequate food intake for patients with aspiration pneumonia. Patients and Methods: This comparative retrospective study included 101 patients hospitalized with aspiration pneumonia between April 2015 and November 2017. We compared the parameters of patients for whom decisions on resumption of oral intake were aided by our protocol against those of patients from the previous year when the protocol was not used. We counted the days until either resumption of oral intake or events of aspiration/choking. Results: The duration of days until oral intake in the two groups was 1.64 ± 2.34 days in the protocol group (56 patients) and 2.09 ± 2.30 days in the control group (45 patients) (P=0.52). The adverse events of aspiration/choking were less frequent in the protocol group (5 vs. 15, odds ratio (OR) 0.32, P<0.001) as compared to the control group. The protocol group showed a significant reduction in aspiration/choking (OR 0.19, P<0.01). Conclusion: Clinical decision-making based on the protocol seems to help non-expert doctors make informed decisions regarding resuming oral intake after aspiration pneumonia.
Collapse
Affiliation(s)
- Yohei Kanzawa
- Department of General Internal Medicine, Akashi Medical
Center, Japan
- Department of Healthcare Economics and Quality Management,
Kyoto University, Japan
| | - Hiroyuki Seto
- Department of Healthcare Economics and Quality Management,
Kyoto University, Japan
- Department of General Internal Medicine, Takatsuki General
Hospital, Japan
| | - Toshio Shimokawa
- Clinical Study Support Center, Wakayama Medical University,
Japan
| | - Takahiko Tsutsumi
- Department of Healthcare Economics and Quality Management,
Kyoto University, Japan
- Department of General Internal Medicine, Takatsuki General
Hospital, Japan
| | - Naoto Ishimaru
- Department of General Internal Medicine, Akashi Medical
Center, Japan
| | - Saori Kinami
- Department of General Internal Medicine, Akashi Medical
Center, Japan
| | - Yuichi Imanaka
- Department of Healthcare Economics and Quality Management,
Kyoto University, Japan
| |
Collapse
|
3
|
Wagner S, Rosian-Schikuta I, Cabral J. Oral-care adherence. Service design for nursing homes - initial caregiver reactions and socio-economic analysis. GERMAN MEDICAL SCIENCE : GMS E-JOURNAL 2022; 20:Doc04. [PMID: 35465638 PMCID: PMC9006315 DOI: 10.3205/000306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/18/2022] [Indexed: 11/16/2022]
Abstract
Background: Lack of proper oral care among elderly people in nursing homes is associated with increased morbidity and hospitalisation. The ability of the individual to maintain sufficient oral self-care is difficult for caregivers to assess, and thus, caregivers often risk providing suboptimal oral care. Sensor-based tools exist that can support the caregiving staff in achieving a better understanding of who among the elderly are able to perform proper self-care, and who cannot and thus need additional assistance from caregivers. How such systems should be designed and deployed in nursing homes, and how they will be perceived by caregivers has not been investigated sufficiently yet. Objectives: The aim of this study was to gain a better understanding of how caregiving staff perceives the introduction of sensor-based systems that allow the caregivers to automatically discover who among the elderly residents are able to adhere to the given recommendation on daily oral self-care, and who among them are in need of further assistance, as well as whether there is potential for saving costs. Methods: In a mixed methods qualitative study, we visited three nursing homes where we had recently deployed, or were about to deploy, electrical toothbrushes and a basic oral-care adherence aid system. Nursing home staff was interviewed during the field studies about their initial reactions to introducing such a system as part of their daily workflow. The field study was supported by a literature review. Results: Caregiving staff welcomed the introduction of a sensor-based oral-care adherence aid system, which would identify any elderly who could no longer achieve a sufficient level of oral self-care. Improving oral care for the elderly may not only prevent serious consequential diseases, but also generate considerable savings with a return on investment of at least 1:2.5. Conclusion: Sensor-based oral-care adherence aid systems that monitor oral-care adherence, meaning the ability of the individual elderly to properly perform teeth and/or denture brushing as part of normal self-care efforts, appear useful and relevant to introduce. More work is needed to provide a better understanding of the long-term user experience of both caregiving staff and elderly. There is also a need for more high-quality long-term clinical studies of further preventive effects of oral hygiene measures and their economic benefit.
Collapse
Affiliation(s)
- Stefan Wagner
- Aarhus University, Aarhus, Denmark,*To whom correspondence should be addressed: Stefan Wagner, Aarhus University, Finlandsgade 22, 8200 Aarhus, Denmark, E-mail:
| | | | | |
Collapse
|
4
|
Wagner SR, Eriksen CLD, Hede B, Christensen LB. Toothbrushing compliance tracking in a nursing home setting using telemonitoring-enabled powered toothbrushes. Br Dent J 2021:10.1038/s41415-021-3169-7. [PMID: 34239058 DOI: 10.1038/s41415-021-3169-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 10/27/2020] [Indexed: 11/09/2022]
Abstract
Introduction Nursing home residents with cognitive and physical disabilities often depend on assistance from caregivers to perform personal hygiene tasks including toothbrushing. Only a minority receives the care needed and toothbrushing compliance levels are not registered.Aims To describe toothbrushing compliance levels in a nursing home setting and investigate the relevance and practicality of using telemonitoring-enabled powered toothbrushes for automated compliance tracking. Furthermore, to investigate changes in plaque and bleeding scores.Materials and methods Nursing home residents were provided with powered toothbrushes and telemonitoring gateways. Toothbrushing frequency and duration were automatically recorded by the telemonitoring gateways, and an email report was sent once a week to the nursing home manager. Plaque index and bleeding index were assessed by dentists at baseline, at the end of the intervention and at three months post-intervention.Results Data from 20 participants for 100 days (3,920 measurements) were collected and used to evaluate toothbrushing compliance. A minority of toothbrushings (5%) were in compliance with the two-minute toothbrushing duration recommendation, while around 30% achieved the one-minute toothbrushing minimum duration recommendation. Around 25% of participants would get only one toothbrushing per day, while 40% would get none. Both plaque and bleeding scores improved significantly during the project, but all progress was lost three months after the project's end.Conclusions It is relevant and practical to monitor toothbrushing compliance in the nursing home setting using telemonitoring-enabled powered toothbrushes. Despite finding limited compliance levels, a significant improvement in the plaque and bleeding index was found after the intervention, which was lost again three months after the telemonitoring gateways had been removed.
Collapse
Affiliation(s)
- Stefan Rahr Wagner
- Department of Electrical and Computer Engineering, Aarhus University, Finlandsgade 22, Aarhus, 8200, Denmark.
| | | | - Børge Hede
- Department for Community Dentistry, School of Dentistry, Faculty of Health Sciences, University of Copenhagen, Nørre Allé 20, Copenhagen, 2200, Denmark
| | - Lisa Bøge Christensen
- Department for Community Dentistry, School of Dentistry, Faculty of Health Sciences, University of Copenhagen, Nørre Allé 20, Copenhagen, 2200, Denmark
| |
Collapse
|
5
|
Mammen MJ, Scannapieco FA, Sethi S. Oral-lung microbiome interactions in lung diseases. Periodontol 2000 2020; 83:234-241. [PMID: 32385873 DOI: 10.1111/prd.12301] [Citation(s) in RCA: 85] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The proximity and continuity of the oral cavity and the lower respiratory tract allows the oropharyngeal microbiome to be a major determinant of the lung microbiome. In addition, host-pathogen interactions related to the oropharyngeal microbiome or its metabolites could propagate systemic inflammation or modulate host defense mechanisms that could affect other organs, including the lung. There is increasing appreciation of the pathophysiologic significance of the lung microbiome, not only in the classical infection-related diseases, pneumonia, bronchiectasis, and cystic fibrosis, but also in chronic noninfectious lung diseases, such as chronic obstructive pulmonary disease, asthma, and pulmonary fibrosis. In this review, we will explore the relationship of the oral microbiome with lung diseases, such as pneumonia, chronic obstructive pulmonary disease, asthma, and cystic fibrosis.
Collapse
Affiliation(s)
- Manoj J Mammen
- Division of Pulmonary, Critical Care, and Sleep Medicine, Jacobs School of Medicine, University at Buffalo, State University of New York, Buffalo, New York, USA
| | - Frank A Scannapieco
- Department of Oral Biology, School of Dental Medicine, University at Buffalo, State University of New York, Buffalo, New York, USA
| | - Sanjay Sethi
- Division of Pulmonary, Critical Care, and Sleep Medicine, Jacobs School of Medicine, University at Buffalo, State University of New York, Buffalo, New York, USA.,Veterans Affairs Western New York Healthcare System, Buffalo, New York, USA
| |
Collapse
|
6
|
Zimmerman S, Sloane PD, Ward K, Wretman CJ, Stearns SC, Poole P, Preisser JS. Effectiveness of a Mouth Care Program Provided by Nursing Home Staff vs Standard Care on Reducing Pneumonia Incidence: A Cluster Randomized Trial. JAMA Netw Open 2020; 3:e204321. [PMID: 32558913 PMCID: PMC7305523 DOI: 10.1001/jamanetworkopen.2020.4321] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 03/01/2020] [Indexed: 12/30/2022] Open
Abstract
Importance Pneumonia affects more than 250 000 nursing home (NH) residents annually. A strategy to reduce pneumonia is to provide daily mouth care, especially to residents with dementia. Objective To evaluate the effectiveness of Mouth Care Without a Battle, a program that increases staff knowledge and attitudes regarding oral hygiene, changes mouth care, and improves oral hygiene, in reducing the incidence of pneumonia among NH residents. Design, Setting, and Participants This pragmatic cluster randomized trial observing 2152 NH residents for up to 2 years was conducted from September 2014 to May 2017. Data collectors were masked to study group. The study included 14 NHs from regions of North Carolina that evidenced proportionately high rehospitalization rates for pneumonia and long-term care residents. Nursing homes were pair matched and randomly assigned to intervention or control groups. Intervention Mouth Care Without a Battle is a standardized program that teaches that mouth care is health care, provides instruction on individualized techniques and products for mouth care, and trains caregivers to provide care to residents who are resistant and in special situations. The control condition was standard mouth care. Main Outcomes and Measures Pneumonia incidence (primary) and hospitalization and mortality (secondary), obtained from medical records. Results Overall, the study enrolled 2152 residents (mean [SD] age, 79.4 [12.4] years; 1281 [66.2%] women; 1180 [62.2%] white residents). Participants included 1219 residents (56.6%) in 7 intervention NHs and 933 residents (43.4%) in 7 control NHs. During the 2-year study period, the incidence rate of pneumonia per 1000 resident-days was 0.67 and 0.72 in the intervention and control NHs, respectively. Neither the primary (unadjusted) nor secondary (covariate-adjusted) analyses found a significant reduction in pneumonia due to Mouth Care Without a Battle during 2 years (unadjusted incidence rate ratio, 0.90; upper bound of 1-sided 95% CI, 1.24; P = .27; adjusted incidence rate ratio, 0.92; upper bound of 1-sided 95% CI, 1.27; P = .30). In the second year, the rate of pneumonia was nonsignificantly higher in intervention NHs. Adjusted post hoc analyses limited to the first year found a significant reduction in pneumonia incidence in intervention NHs (IRR, 0.69; upper bound of 1-sided 95% CI, 0.94; P = .03). Conclusions and Relevance This matched-pairs cluster randomized trial of a mouth care program compared with standard care was not effective in reducing pneumonia incidence at 2 years, although reduction was found during the first year. The lack of significant results in the second year may be associated with sustainability. Improving mouth care in US NHs may require the presence and support of dedicated oral care aides. Trial Registration ClinicalTrials.gov Identifier: NCT03817450.
Collapse
Affiliation(s)
- Sheryl Zimmerman
- The Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill
- School of Social Work, University of North Carolina at Chapel Hill
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill
| | - Philip D. Sloane
- The Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill
- Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill
| | - Kimberly Ward
- The Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill
| | - Christopher J. Wretman
- The Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill
- School of Social Work, University of North Carolina at Chapel Hill
| | - Sally C. Stearns
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill
| | - Patricia Poole
- The Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill
| | - John S. Preisser
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill
| |
Collapse
|
7
|
Affiliation(s)
- Lionel A Mandell
- From McMaster University, Hamilton, ON, Canada (L.A.M.); and Weill Cornell Medical College, New York (M.S.N.)
| | - Michael S Niederman
- From McMaster University, Hamilton, ON, Canada (L.A.M.); and Weill Cornell Medical College, New York (M.S.N.)
| |
Collapse
|
8
|
Zimmerman S, Sloane PD. The Epidemic of Poor Oral Hygiene. J Am Med Dir Assoc 2018; 19:1031-1032. [PMID: 30471796 DOI: 10.1016/j.jamda.2018.10.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 10/19/2018] [Indexed: 10/27/2022]
Affiliation(s)
- Sheryl Zimmerman
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC; Schools of Social Work and Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC.
| | - Philip D Sloane
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC; Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC.
| |
Collapse
|
9
|
Affiliation(s)
- Carol W. Bassim
- Department of Health Research Methods, Evidence, and Impact; McMaster University; Hamilton Canada
| |
Collapse
|