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Goto A, Komiya K, Umeki K, Hiramatsu K, Kadota JI. Impact of Antibiotics Used for Acute Aspiration Bronchitis on the Prevention of Pneumonia. Geriatrics (Basel) 2024; 9:26. [PMID: 38525743 PMCID: PMC10961750 DOI: 10.3390/geriatrics9020026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 02/17/2024] [Accepted: 02/23/2024] [Indexed: 03/26/2024] Open
Abstract
BACKGROUNDS It remains unclear if antibiotics should be used for the treatment of acute aspiration bronchitis to prevent the development of pneumonia. This study aimed to assess the associations between the use of antibiotics and the development of pneumonia among patients with acute aspiration bronchitis. METHODS We retrospectively reviewed consecutive patients with acute aspiration bronchitis aged ≥75 years. Acute aspiration bronchitis was defined as a condition with aspiration risk, high fever (body temperature, ≥37.5 °C), respiratory symptoms, and the absence of evidence of pneumonia. RESULTS There was no significant difference in the incidence of pneumonia between patients treated with and without antibiotics for acute aspiration bronchitis (6/44, 14% vs. 31/143, 22%; p = 0.242). Lower estimated glomerular filtration rate (adjusted odds ratio, 0.956; 95% confidence interval, 0.920-0.993) was significantly associated with the development of pneumonia. CONCLUSIONS Antibiotic administration should not be routinely recommended to prevent pneumonia following acute aspiration bronchitis, and patients with decreased renal function should be closely monitored. A randomized controlled trial is necessary to validate these results.
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Affiliation(s)
- Akihiko Goto
- Department of Respiratory Medicine, Tenshindo Hetsugi Hospital, 5956 Nihongi, Nakahetsugi, Oita 879-7761, Japan
| | - Kosaku Komiya
- Department of Respiratory Medicine, Tenshindo Hetsugi Hospital, 5956 Nihongi, Nakahetsugi, Oita 879-7761, Japan
- Department of Respiratory Medicine and Infectious Diseases, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama-machi, Yufu 879-5593, Japan
| | - Kenji Umeki
- Department of Respiratory Medicine, Tenshindo Hetsugi Hospital, 5956 Nihongi, Nakahetsugi, Oita 879-7761, Japan
| | - Kazufumi Hiramatsu
- Department of Medical Safety Management, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama-machi, Yufu 879-5593, Japan
| | - Jun-ichi Kadota
- Department of Respiratory Medicine and Infectious Diseases, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama-machi, Yufu 879-5593, Japan
- Nagasaki Harbor Medical Center, 6-39 Shinchi-machi, Nagasaki 850-8555, Japan
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2
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Caruso AM, Bommarito D, Girgenti V, Amato G, Figuccia A, Casuccio A, Ferlisi A, Genuardi R, La Fata S, Mattei R, Milazzo MPM, Di Pace MR. Evaluation of Dysphagia and Inhalation Risk in Neurologically Impaired Children Using Esophageal High-Resolution Manometry with Swallowing Analysis. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9121987. [PMID: 36553430 PMCID: PMC9777053 DOI: 10.3390/children9121987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 12/09/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Dysphagia in neurologically impaired children is associated with feeding difficulties, malnutrition and aspiration pneumonia. Esophageal high-resolution manometry (HRM) has been used in the diagnosis of motility disorders affecting the swallowing process. The aim of this study was to analyze swallowing functions in NI children by using HRM in order to establish swallow parameters identifying inhalation risk. METHODS Twenty-five NI children with cerebral palsy were submitted to esophageal HRM with UES analysis, comparing the results with non-NI children. The following parameters were evaluated: maximum pressure and duration of contraction of the velopharynx (VP) and tongue base (TB), and maximal, minimal, resting pressure and relaxation duration of the upper esophageal sphincter (UES). RESULTS pVP max, pTB max, pUES max and resting pressure were lower, while p UES minimal was higher and relaxation duration was shorter in NI children vs. the control group. Predictive values of inhalation risk were evaluated. CONCLUSIONS This study evaluates inhalation risk in NI children using HRM to study UES function. Our results confirm the alterations described in NI children: insufficient contraction and clearing force for bolus transmission through the pharynx and incomplete UES relaxation can predispose to pharyngeal residues and inhalation independently of swallowing because of lower values of UES resting.
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Affiliation(s)
- Anna Maria Caruso
- Pediatric Surgical Unit, Children’s Hospital ‘G. di Cristina’, ARNAS Civico, 4, 90127 Palermo, Italy
- Correspondence: ; Tel.: +39-091-6666-009; Fax: +39-091-6666-006
| | - Denisia Bommarito
- Pediatric Surgical Unit, Children’s Hospital ‘G. di Cristina’, ARNAS Civico, 4, 90127 Palermo, Italy
| | - Vincenza Girgenti
- Pediatric Surgical Unit, Children’s Hospital ‘G. di Cristina’, ARNAS Civico, 4, 90127 Palermo, Italy
| | - Glenda Amato
- Pediatric Surgical Unit, Children’s Hospital ‘G. di Cristina’, ARNAS Civico, 4, 90127 Palermo, Italy
| | - Adele Figuccia
- Pediatric Surgical Unit, Department Health Promotion, of Mother and Child Care, Internal Medicine and Medical Specialities, University of Palermo, 61, 90133 Palermo, Italy
| | - Alessandra Casuccio
- Pediatric Surgical Unit, Department Health Promotion, of Mother and Child Care, Internal Medicine and Medical Specialities, University of Palermo, 61, 90133 Palermo, Italy
| | - Annalisa Ferlisi
- Cystic Fibrosis and Respiratory Pediatric Unit, Children’s Hospital ‘G. di Cristina’, ARNAS Civico, 4, 90127 Palermo, Italy
| | - Rosaria Genuardi
- Pediatric Anestesiologit Intensive Unit Care Children’s Hospital ‘G. di Cristina’, ARNAS Civico, 4, 90127 Palermo, Italy
| | - Sabrina La Fata
- Medical Direction, Pediatric Nutritional Service, Children’s Hospital ‘G. di Cristina’, ARNAS Civico, 4, 90127 Palermo, Italy
| | - Rosalia Mattei
- Pediatric Surgical Unit, Children’s Hospital ‘G. di Cristina’, ARNAS Civico, 4, 90127 Palermo, Italy
| | | | - Maria Rita Di Pace
- Pediatric Surgical Unit, Department Health Promotion, of Mother and Child Care, Internal Medicine and Medical Specialities, University of Palermo, 61, 90133 Palermo, Italy
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3
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Patel N, Chong K, Baydur A. Methods and Applications in Respiratory Physiology: Respiratory Mechanics, Drive and Muscle Function in Neuromuscular and Chest Wall Disorders. Front Physiol 2022; 13:838414. [PMID: 35774289 PMCID: PMC9237333 DOI: 10.3389/fphys.2022.838414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 05/10/2022] [Indexed: 11/13/2022] Open
Abstract
Individuals with neuromuscular and chest wall disorders experience respiratory muscle weakness, reduced lung volume and increases in respiratory elastance and resistance which lead to increase in work of breathing, impaired gas exchange and respiratory pump failure. Recently developed methods to assess respiratory muscle weakness, mechanics and movement supplement traditionally employed spirometry and methods to evaluate gas exchange. These include recording postural change in vital capacity, respiratory pressures (mouth and sniff), electromyography and ultrasound evaluation of diaphragmatic thickness and excursions. In this review, we highlight key aspects of the pathophysiology of these conditions as they impact the patient and describe measures to evaluate respiratory dysfunction. We discuss potential areas of physiologic investigation in the evaluation of respiratory aspects of these disorders.
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4
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Suresh MV, Yalamanchili G, Rao TC, Aktay S, Kralovich A, Shah YM, Raghavendran K. Hypoxia‐inducible factor (HIF)‐1α‐induced regulation of lung injury in pulmonary aspiration is mediated through NF‐kB. FASEB Bioadv 2022; 4:309-328. [PMID: 35520392 PMCID: PMC9065579 DOI: 10.1096/fba.2021-00132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 12/22/2021] [Accepted: 12/27/2021] [Indexed: 11/11/2022] Open
Abstract
Aspiration‐induced lung injury is a common grievance encountered in the intensive care unit (ICU). It is a significant risk factor for improving ventilator‐associated pneumonia (VAP) and acute respiratory distress syndrome (ARDS). Hypoxia‐inducible factor (HIF)‐1α is one of the primary transcription factors responsible for regulating the cellular response to changes in oxygen tension. Here, we sought to determine the role of HIF‐1α and specifically the role of type 2 alveolar epithelial cells in generating the acute inflammatory response following acid and particles (CASP) aspiration. Previous studies show HIF‐1 α is involved in regulating the hypoxia‐stimulated expression of MCP‐1 in mice and humans. The CASP was induced in C57BL/6, ODD‐Luc, HIF‐1α (+/+) control, and HIF‐1α conditional knockout (HIF‐1α (−/−) mice). Following an injury in ODD mice, explanted organs were subjected to IVIS imaging to measure the degree of hypoxia. HIF‐1α expression, BAL albumin, cytokines, and histology were measured following CASP. In C57BL/6 mice, the level of HIF‐1α was increased at 1 h after CASP. There were significantly increased levels of albumin and cytokines in C57BL/6 and ODD‐Luc mice lungs following CASP. HIF‐1α (+/+) mice given CASP demonstrated a synergistic increase in albumin leakage, increased pro‐inflammatory cytokines, and worse injury. MCP‐1 antibody neutralized HIF‐1α (+/+) mice showed reduced granuloma formation. The NF‐κB expression was increased substantially in the HIF‐1α (+/+) mice following CASP compared to HIF‐1α (−/−) mice. Our data collectively identify that HIF‐1α upregulation of the acute inflammatory response depends on NF‐κB following CASP.
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Affiliation(s)
| | | | - Tejeshwar C. Rao
- Department of Cell, Developmental, and Integrative Biology The University of Alabama at Birmingham Birmingham UK
| | - Sinan Aktay
- Department of Surgery University of Michigan Ann Arbor Michigan USA
| | - Alex Kralovich
- Department of Surgery University of Michigan Ann Arbor Michigan USA
| | - Yatrik M. Shah
- Molecular & Integrative Physiology University of Michigan Ann Arbor Michigan USA
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5
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Kosutova P, Mikolka P. Aspiration syndromes and associated lung injury: incidence, pathophysiology and management. Physiol Res 2021. [DOI: 10.33549//physiolres.934767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Aspiration is a common condition affecting healthy or sick patients which could create an acute or chronic inflammatory reaction in the lungs. Aspiration syndromes could be categorized according to a content entering the respiratory system into bacterial aspiration pneumonia with the gastric or oropharyngeal bacteria entering, aspiration chemical pneumonitis with bacteria-freegastric acid aspiration, or aspiration of a foreign body which causes an acute pulmonary emergency. There are differences in the clinical presentation of volume-dependent aspirations (microaspiration and macroaspiration): the higher is the volume of aspiration, the greater is the injury to the patient and more serious are the health consequences (with 70 % mortality rate for hospitalized patients). Aspiration syndromes can affect both the airways and pulmonary parenchyma, leading to acute lung injury, increased hospitalization rate and worse outcomes in critically ill patients. Impaired alveolar-capillary permeability, oedema formation, neutrophilic inflammatory response and pulmonary surfactant inactivation lead to reduced lung compliance and loss of aerated lung tissue and give rise to hypoxemia and respiratory failure. This review discusses the effect of aspiration events on the pulmonary tissue. The main focus is to distinguish the differences between bacterial and chemical pneumonia, their clinical presentation and symptoms, risk factors of developing the changes, possibilities of diagnostics and management as well as prevention of aspirations. Because of a risk of serious lung damage after the aspiration, pathophysiology and processes leading to lung tissue injury are discussed in detail. Data sources represent a systematic literature search using relevant medical subject headings.
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6
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Mohammed OS, Kambouche F, Amirthalingam P. Chemical pneumonitis due to accidental inhalation of benzene: A case report. Respir Med Case Rep 2020; 29:100981. [PMID: 31890558 PMCID: PMC6928352 DOI: 10.1016/j.rmcr.2019.100981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 12/09/2019] [Accepted: 12/09/2019] [Indexed: 11/24/2022] Open
Abstract
Acute accidental inhaled benzene toxicity is rare; however, it associates with the complications including chemical pneumonitis frequently and rarely with the cardiac and neurological complications. The patient should be treated symptomatically since there are no specific clinical practice guidelines especially antidotes established in this regard. The follow-up and monitoring of the patient are crucial for the remission and also to rule out further complications.
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7
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Suresh MV, Balijepalli S, Zhang B, Singh VV, Swamy S, Panicker S, Dolgachev VA, Subramanian C, Ramakrishnan SK, Thomas B, Rao TC, Delano MJ, Machado-Aranda D, Shah YM, Raghavendran K. Hypoxia-Inducible Factor (HIF)-1α Promotes Inflammation and Injury Following Aspiration-Induced Lung Injury in Mice. Shock 2019; 52:612-621. [PMID: 30601332 PMCID: PMC6591116 DOI: 10.1097/shk.0000000000001312] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Acid aspiration-induced lung injury is a common disease in the intensive care unit (ICU) and acute respiratory distress syndrome (ARDS). Hypoxia-inducible factor (HIF)-1α is a major transcription factor responsible for regulating the cellular response to changes in oxygen tension. A clear understanding of the function of HIF-1α in lung inflammatory response is currently lacking. Here, we sought to determine the role of HIF-1α in type 2 alveolar epithelial cells (AEC) in the generation of the acute inflammatory response following gastric aspiration (GA). GA led to profound hypoxia at very early time points following GA. This correlated to a robust increase in HIF-1α, tissue albumin and pro-inflammatory mediators following GA in AECs. The extent of lung injury and the release of pro/anti-inflammatory cytokines were significantly reduced in HIF-1α (-/-) mice. Finally, we report that HIF-1α upregulation of the acute inflammatory response is dependent on NF-κB following GA.
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Affiliation(s)
| | | | - Boya Zhang
- Department of Surgery, University of Michigan, Ann Arbor
| | | | - Samantha Swamy
- Department of Surgery, University of Michigan, Ann Arbor
| | | | | | | | | | - Bivin Thomas
- Department of Surgery, University of Michigan, Ann Arbor
| | - Tejeshwar C. Rao
- Department of Cell, Development and Integrative Biology, University of Alabama at Birmingham, Birmingham
| | | | | | - Yatrik M. Shah
- Molecular & Integrative Physiology, University of Michigan, Ann Arbor
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8
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Johnson TW, RN SS, Epp L, Mundi MS. Addressing Frequent Issues of Home Enteral Nutrition Patients. Nutr Clin Pract 2019; 34:186-195. [DOI: 10.1002/ncp.10257] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Teresa W. Johnson
- Department of Kinesiology & Health Promotion; Troy University; Troy AL USA
| | | | - Lisa Epp
- Mayo Clinic; Rochester Minnesota USA
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9
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Ohashi Y, Walker JC, Zhang F, Prindiville FE, Hanrahan JP, Mendelson R, Corcoran T. Preoperative Gastric Residual Volumes in Fasted Patients Measured by Bedside Ultrasound: A Prospective Observational Study. Anaesth Intensive Care 2018; 46:608-613. [DOI: 10.1177/0310057x1804600612] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The purpose of this prospective observational study was to measure gastric volumes in fasted patients using bedside gastric ultrasound. Patients presenting for non-emergency surgery underwent a gastric antrum assessment, using the two-diameter and free-trace methods to determine antral cross-sectional area. Gastric residual volume (GRV) was calculated using a validated formula. Univariate and multivariable analyses were performed to examine any potential relationships between ‘at risk’ GRVs (>100 ml) and patient factors. Two hundred and twenty-two successful scans were performed; of these 110 patients (49.5%) had an empty stomach, nine patients (4.1%) had a GRV >100 ml, and a further six patients (2.7%) had a GRV >1.5 ml/kg. There was no significant relationship between ‘at risk’ GRV and obesity, diabetes mellitus, gastro-oesophageal reflux disease or opioid use, although our study had insufficient power to exclude an influence of one or more of these factors. Our results indicate that despite compliance with fasting guidelines, a small percentage of patients still have GRVs that pose a pulmonary aspiration risk. Anaesthetists should consider this background incidence when choosing anaesthesia techniques for their patients. While future observational studies are required to determine the role of preoperative bedside gastric ultrasound, it is possible that this technique may assist anaesthetists in identifying patients with ‘at risk’ GRVs.
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Affiliation(s)
- Y. Ohashi
- Department of Anaesthesia and Pain Medicine, Fiona Stanley Fremantle Hospitals Group, Perth, Western Australia
| | - J. C. Walker
- Consultant Anaesthetist, Anaesthetic Department, Royal Bournemouth Hospital, Bournemouth, United Kingdom
| | - F. Zhang
- Department of Radiology, Sir Charles Gairdner Hospital, Perth, Western Australia
| | - F. E. Prindiville
- Sonographer, Department of Imaging Services, Royal Perth Hospital, Perth, Western Australia
| | - J. P. Hanrahan
- General Practitioner, Queens Park Medical Centre, Perth, Western Australia
| | - R. Mendelson
- Emeritus Consultant Radiologist, Department of Diagnostic and Interventional Radiology, Royal Perth Hospital; Clinical Professor, University of Western Australia; Adjunct Professor, Notre Dame University; Perth, Western Australia
| | - T. Corcoran
- Director of Research, Department of Anaesthesia and Pain Medicine, Royal Perth Hospital; Clinical Professor, School of Medicine and Pharmacology, University of Western Australia; Raine Clinical Research Fellow, Raine Foundation/WA Health Department; Adjunct Clinical Professor, School of Public Health and Preventive Medicine, Monash University Australia; Perth, Western Australia
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10
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Bisinotto FMB, Pansani PL, Silveira LAMD, Naves ADA, Peixoto ACA, Lima HMD, Martins LB. Qualitative and quantitative ultrasound assessment of gastric content. Rev Assoc Med Bras (1992) 2017; 63:134-141. [PMID: 28355374 DOI: 10.1590/1806-9282.63.02.134] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 09/03/2016] [Indexed: 11/22/2022] Open
Abstract
Objective: Pulmonary aspiration of the gastric contents is one of the most feared complications in anesthesia. Its prevention depends on preoperative fasting as well as identification of risky patients. A reliable diagnostic tool to assess gastric volume is currently lacking. The aim of this study performed on volunteers was to evaluate the feasibility of ultrasonography to identify qualitative and quantitative gastric content. Method: A standardized gastric scanning protocol was applied on 67 healthy volunteers to assess the gastric antrum in four different situations: fasting, after ingesting clear fluid, milk and a solid meal. A qualitative and quantitative assessment of the gastric content in the antrum was performed by a blinded sonographer. The antrum was considered either as empty, or containing clear or thick fluid, or solids. Total gastric volume was predicted based on a cross-sectional area of the antrum. A p-value less than 0.05 was considered statistically significant. Results: For each type of gastric content, the sonographic characteristics of the antrum and its content were described and illustrated. Sonographic qualitative assessment allowed to distinguish between an empty stomach and one with different kinds of meal. The predicted gastric volume was significantly larger after the consumption of any food source compared to fasting. Conclusion: Bedside sonography can determine the nature of gastric content. It is also possible to estimate the difference between an empty gastric antrum and one that has some food in it. Such information may be useful to estimate the risk of aspiration, particularly in situations when prandial status is unknown or uncertain.
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Affiliation(s)
- Flora Margarida Barra Bisinotto
- MD, Anesthesiologist. PhD in Anesthesiology. Adjunct Professor, Department of Surgery, Universidade Federal do Triângulo Mineiro (UFTM), Uberaba, MG, Brazil
| | - Patrícia Luísa Pansani
- MD, Anesthesiologist. Medical Residency in Anesthesiology at the Teaching and Training Center (CET)/Sociedade Brasileira de Anestesiologia (SBA), Hospital de Clínicas da UFTM, Uberaba, MG, Brazil
| | | | | | | | - Hellen Moreira de Lima
- Medical Student at UFMT, Scientific Initiation Grant from UFTM (BIC/Fapemig), Uberaba, MG, Brazil
| | - Laura Bisinotto Martins
- Medical Student at Universidade de Ribeirão Preto, Scientific Initiation Grant from UFTM, Ribeirão Preto, SP, Brazil
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11
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Son YG, Shin J, Ryu HG. Pneumonitis and pneumonia after aspiration. J Dent Anesth Pain Med 2017; 17:1-12. [PMID: 28879323 PMCID: PMC5564131 DOI: 10.17245/jdapm.2017.17.1.1] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Revised: 02/19/2017] [Accepted: 02/20/2017] [Indexed: 12/25/2022] Open
Abstract
Aspiration pneumonitis and aspiration pneumonia are clinical syndromes caused by aspiration. These conditions are clinically significant due to their high morbidity and mortality. However, aspiration as a preceding event are often unwitnessed, particularly in cases of asymptomatic or silent aspiration. Furthermore, despite the difference in treatment approaches for managing aspiration pneumonitis and aspiration pneumonia, these two disease entities are often difficult to discriminate from one another, resulting in inappropriate treatment. The use of unclear terminologies hinders the comparability among different studies, making it difficult to produce evidence-based conclusions and practical guidelines. We reviewed the most recent studies to define aspiration, aspiration pneumonitis, and aspiration pneumonia, and to further assess these conditions in terms of incidence and epidemiology, pathophysiology, risk factors, diagnosis, management and treatment, and prevention.
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Affiliation(s)
- Young Gon Son
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jungho Shin
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Ho Geol Ryu
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
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12
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Boullata JI, Carrera AL, Harvey L, Escuro AA, Hudson L, Mays A, McGinnis C, Wessel JJ, Bajpai S, Beebe ML, Kinn TJ, Klang MG, Lord L, Martin K, Pompeii-Wolfe C, Sullivan J, Wood A, Malone A, Guenter P. ASPEN Safe Practices for Enteral Nutrition Therapy [Formula: see text]. JPEN J Parenter Enteral Nutr 2016; 41:15-103. [PMID: 27815525 DOI: 10.1177/0148607116673053] [Citation(s) in RCA: 235] [Impact Index Per Article: 29.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Enteral nutrition (EN) is a valuable clinical intervention for patients of all ages in a variety of care settings. Along with its many outcome benefits come the potential for adverse effects. These safety issues are the result of clinical complications and of process-related errors. The latter can occur at any step from patient assessment, prescribing, and order review, to product selection, labeling, and administration. To maximize the benefits of EN while minimizing adverse events requires that a systematic approach of care be in place. This includes open communication, standardization, and incorporation of best practices into the EN process. This document provides recommendations based on the available evidence and expert consensus for safe practices, across each step of the process, for all those involved in caring for patients receiving EN.
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Affiliation(s)
- Joseph I Boullata
- 1 Clinical Nutrition Support Services, Hospital of the University of Pennsylvania and Department of Nutrition, Drexel University, Philadelphia, Pennsylvania, USA
| | | | - Lillian Harvey
- 3 Northshore University Hospital, Manhasset, New York, and Hofstra University NorthWell School of Medicine, Garden City, New York, USA
| | - Arlene A Escuro
- 4 Digestive Disease Institute Cleveland Clinic Cleveland, Ohio, USA
| | - Lauren Hudson
- 5 Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Andrew Mays
- 6 Baptist Health Systems and University of Mississippi School of Pharmacy, Jackson, Mississippi, USA
| | - Carol McGinnis
- 7 Sanford University of South Dakota Medical Center, Sioux Falls, South Dakota, USA
| | | | - Sarita Bajpai
- 9 Indiana University Health, Indianapolis, Indiana, USA
| | | | - Tamara J Kinn
- 11 Loyola University Medical Center, Maywood, Illinois, USA
| | - Mark G Klang
- 12 Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Linda Lord
- 13 University of Rochester Medical Center, Rochester, New York, USA
| | - Karen Martin
- 14 University of Texas Center for Health Sciences at San Antonio, San Antonio, Texas, USA
| | - Cecelia Pompeii-Wolfe
- 15 University of Chicago, Medicine Comer Children's Hospital, Chicago, Illinois, USA
| | | | - Abby Wood
- 17 Baylor University Medical Center, Dallas, Texas, USA
| | - Ainsley Malone
- 18 American Society for Enteral and Parenteral Nutrition, Silver Spring, Maryland, USA
| | - Peggi Guenter
- 18 American Society for Enteral and Parenteral Nutrition, Silver Spring, Maryland, USA
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13
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14
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Abstract
Nutrition therapy is an essential aspect of patient care and an important determinant of outcomes in the ICU. Nutrition can impact respiratory function in a myriad of ways. Under- and overfeeding are two well-established ways by which nutrition impinges on respiratory function. Route of feeding, method of feeding, and carbohydrate composition of the diet are also other key factors regarding nutrition that influence outcomes in ICU patients. Recent studies are now elucidating the role of immune therapy in patients with acute respiratory distress syndrome. In the ICU, nutrition dogmas, such as the necessity of checking gastric residual volumes or utilizing full-calorie enteric feeds, as opposed to trophic feeds, are constantly being challenged by innovative clinical studies. Basic research brings the prospect of testing new approaches for ICU patients, such as the use of antioxidants to prevent diaphragm weakness in these patients. In this review article, we evaluate the recent observational and randomized control trials to critically appraise the evidence regarding nutrition in the ICU.
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15
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Alaçam H, Karlı R, Alıcı Ö, Avcı B, Güzel A, Kozan A, Mertoğlu C, Murat N, Şalış O, Güzel A, Şahin M. The effects of α-tocopherol on oxidative damage and serum levels of Clara cell protein 16 in aspiration pneumonitis induced by bile acids. Hum Exp Toxicol 2012; 32:53-61. [DOI: 10.1177/0960327112459531] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Our aim in this study is to examine the effects of α-tocopherol (AT) on rats with aspiration pneumonitis induced with bile acids (BAs). The animals were divided in to four groups, namely saline group ( n = 7), saline + AT group ( n = 7), BA group ( n = 7), and BA + AT group ( n = 7). Saline and BA groups aspirated intratracheally with 1 ml/kg saline and 1 ml/kg bile acids, respectively. AT was given at 20 mg/kg/day dosage for 7 days to the groups. AT group was given 20 mg/kg/day AT for 7 days. Malondialdehyde (MDA), Clara cell protein 16 (CC-16), catalase (CAT), superoxide dismutase (SOD), as well as peribronchial inflammatory cell infiltration, alveolar septal infiltration, alveolar edema, alveolar exudate, alveolar histiocytes, and necrosis were evaluated. The CAT activity of the BA group was significantly lower than the saline group. In the BA + AT group, there was a significant increase in SOD and CAT activities when compared with that of the BA group. The CC-16 and MDA contents in the BA group were significantly higher than in the saline group. The CC-16 and MDA levels of the BA + AT group were significantly lower than BA group. Histopathologic changes were seen in BA group, and there was a significant decrease in the BA + AT group. In conclusion, AT might be beneficial in the treatment of aspiration pneumonitis induced by BAs because AT decreased oxidative damage and resulted in a decrease in CC-16 levels.
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Affiliation(s)
- H Alaçam
- Department of Medical Biochemistry, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - R Karlı
- Department of Otorhinolaryngology, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Ö Alıcı
- Department of Pathology, Samsun Education and Research Hospital, Samsun, Turkey
| | - B Avcı
- Department of Medical Biochemistry, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - A Güzel
- Department of Chest Disease, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - A Kozan
- Department of Medical Biochemistry, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - C Mertoğlu
- Department of Medical Biochemistry, Faculty of Medicine, Gaziosmanpaşa University, Tokat, Turkey
| | - N Murat
- Department of Statistics, Ondokuz Mayıs University, Samsun, Turkey
| | - O Şalış
- Mental Health and Diseases Hospital, Samsun, Turkey
| | - A Güzel
- Department of Pediatrics, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Turkey
| | - M Şahin
- Department of Medical Biochemistry, Faculty of Medicine, Gaziosmanpaşa University, Tokat, Turkey
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16
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Prabhakaran S, Doraiswamy VA, Nagaraja V, Cipolla J, Ofurum U, Evans DC, Lindsey DE, Seamon MJ, Kavuturu S, Gerlach AT, Jaik NP, Eiferman DS, Papadimos TJ, Adolph MD, Cook CH, Stawicki SPA. Nasoenteric Tube Complications. Scand J Surg 2012; 101:147-55. [DOI: 10.1177/145749691210100302] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The use of nasoenteric tubes (NETs) is ubiquitous, and clinicians often take their placement, function, and maintenance for granted. NETs are used for gastrointestinal decompression, enteral feeding, medication administration, naso-biliary drainage, and specialized indications such as upper gastrointestinal bleeding. Morbidity associated with NETETs is common, but frequently subtle, mandating high index of suspicion, clinical vigilance, and patient safety protocols. Common complications include sinusitis, sore throat and epistaxis. More serious complications include luminal perforation, pulmonary injury, aspiration, and intracranial placement. Frequent monitoring and continual re-review of the indications for continued use of any NETET is prudent, including consideration of changing goals of care. This manuscript reviews NET-related complications and associated topics.
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Affiliation(s)
- S. Prabhakaran
- University of North Dakota, Fargo, ND, U.S.A
- OPUS 12 Foundation Review Group, Plymouth Meeting, PA, U.S.A
| | - V. A. Doraiswamy
- University of Arizona, Tucson, AZ, U.S.A
- OPUS 12 Foundation Review Group, Plymouth Meeting, PA, U.S.A
| | - V. Nagaraja
- University of Arizona, Tucson, AZ, U.S.A
- OPUS 12 Foundation Review Group, Plymouth Meeting, PA, U.S.A
| | - J. Cipolla
- Temple St Luke's Medical School, Bethlehem, PA, U.S.A
- OPUS 12 Foundation Review Group, Plymouth Meeting, PA, U.S.A
| | - U. Ofurum
- Temple St Luke's Medical School, Bethlehem, PA, U.S.A
| | - D. C. Evans
- The Ohio State University Medical Center, Columbus, OH, U.S.A
- OPUS 12 Foundation Review Group, Plymouth Meeting, PA, U.S.A
| | - D. E. Lindsey
- The Ohio State University Medical Center, Columbus, OH, U.S.A
- OPUS 12 Foundation Review Group, Plymouth Meeting, PA, U.S.A
| | - M. J. Seamon
- Cooper University Hospital, Camden, NJ, U.S.A
- OPUS 12 Foundation Review Group, Plymouth Meeting, PA, U.S.A
| | - S. Kavuturu
- OPUS 12 Foundation Review Group, Plymouth Meeting, PA, U.S.A
| | - A. T. Gerlach
- The Ohio State University Medical Center, Columbus, OH, U.S.A
- OPUS 12 Foundation Review Group, Plymouth Meeting, PA, U.S.A
| | - N. P. Jaik
- Vanderbilt University Medical Center, Nashville, TN, U.S.A
- OPUS 12 Foundation Review Group, Plymouth Meeting, PA, U.S.A
| | - D. S. Eiferman
- The Ohio State University Medical Center, Columbus, OH, U.S.A
| | - T. J. Papadimos
- The Ohio State University Medical Center, Columbus, OH, U.S.A
- OPUS 12 Foundation Review Group, Plymouth Meeting, PA, U.S.A
| | - M. D. Adolph
- The Ohio State University Medical Center, Columbus, OH, U.S.A
- OPUS 12 Foundation Review Group, Plymouth Meeting, PA, U.S.A
| | - C. H. Cook
- The Ohio State University Medical Center, Columbus, OH, U.S.A
- OPUS 12 Foundation Review Group, Plymouth Meeting, PA, U.S.A
| | - S. P. A. Stawicki
- The Ohio State University Medical Center, Columbus, OH, U.S.A
- OPUS 12 Foundation Review Group, Plymouth Meeting, PA, U.S.A
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17
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Cubillos J, Tse C, Chan VWS, Perlas A. Bedside ultrasound assessment of gastric content: an observational study. Can J Anaesth 2012; 59:416-23. [PMID: 22215523 DOI: 10.1007/s12630-011-9661-9] [Citation(s) in RCA: 107] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Accepted: 12/20/2011] [Indexed: 12/21/2022] Open
Abstract
PURPOSE There is a growing interest in the use of bedside ultrasonography to assess gastric content and volume. It has been suggested that the gastric antrum in particular can be assessed reliably by sonography. The aim of this observational study was to provide a qualitative description of the sonographic characteristics of the gastric antrum when the stomach is empty and following the ingestion of clear fluid, milk, and solid content. CLINICAL FEATURES Six healthy volunteers were examined on four different occasions (24 scanning sessions): following a period of eight hours of fast and following ingestion of 200 mL of apple juice, 200 mL of 2% milk, and a standard solid meal (sandwich and apple juice). Examinations were performed following a standardized scanning protocol by two clinical anesthesiologists with previous experience in gastric sonography. For each type of gastric content, the sonographic characteristics of the antrum and its content are described and illustrated with figures. CONCLUSIONS Bedside sonography can determine the nature of gastric content (nil, clear fluid, thick fluid/solid). This qualitative information by itself may be useful to assess risk of aspiration, particularly in situations when prandial status is unknown or uncertain.
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Affiliation(s)
- Javier Cubillos
- Department of Anesthesia, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada
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18
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Abstract
OBJECTIVE Aspiration of oropharyngeal or gastric contents into the lower respiratory tract is a common event in critically ill patients and can lead to pneumonia or pneumonitis. Aspiration pneumonia is the leading cause of pneumonia in the intensive care unit and is one of the leading risk factors for acute lung injury and acute respiratory distress syndromes. Despite its frequency, it remains largely a disease of exclusion characterized by ill-defined infiltrates on the chest radiograph and hypoxia. An accurate ability to diagnose aspiration is paramount because different modalities of therapy, if applied early and selectively, could change the course of the disease. This article reviews definitions, diagnosis, epidemiology, pathophysiology, including animal models of aspiration-induced lung injury, and evidence-based clinical management. Additionally, a review of current and potential biomarkers that have been tested clinically in humans is provided. DATA SOURCES Data were obtained from a PubMed search of the medical literature. PubMed "related articles" search strategies were used. SUMMARY AND CONCLUSIONS Aspiration in the intensive care unit is a clinically relevant problem requiring expertise and awareness. A definitive diagnosis of aspiration pneumonitis or pneumonia is challenging to make. Advances in specific biomarker profiles and prediction models may enhance the diagnosis and prognosis of clinical aspiration syndromes. Evidence-based management is supportive, including mechanical ventilation, bronchoscopy for particulate aspiration, consideration of empiric antibiotics for pneumonia treatment, and lower respiratory tract sampling to define pathogenic bacteria that are causative.
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Lee SI, Choi YK, Kang WJ, Park SW, Yi JW, Sung JK. Effects of esomeprazole premedication on gastric pH during laparoscopic surgery. Korean J Anesthesiol 2009; 56:259-264. [PMID: 30625733 DOI: 10.4097/kjae.2009.56.3.259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The use of CO2 for pneumoperitoneum during laparoscopic surgery provokes a decrement in the gastric pH. Since the incidence rate of PONV increases after laparoscopic surgery, the possibility of lung aspiration of gastric juice with a low pH during a postanesthetic emergence may increase and this could be fatal for the patient. We conducted this study to determine the effects of esomeprazole premedication on inhibiting the decrement of the gastric pH during laparoscopic surgery. METHODS 40 adult patients with no underlying diseases were chosen and 20 patients each were grouped as C (the control group) and E (the esomeprazole group). In both group, 0.2 mg glycopyrrolate was given intramuscularly 30 minutes prior to the surgery. In group E, esomeprazole was given orally 2 hours prior to the surgery. The pH, PaCO2, and PETCO2 were measured via pH probe, an ABGA and an capnogram at preinsufflation and 15, 30 and 60 minutes after the CO2 insufflation and right before CO2 exhaustion (predeflation). RESULTS Comparing the measurements of the gastric pH between group E and group C, all the results showed a significant increase in group E (P < 0.05). The difference of the PaCO2 and PETCO2 in the two groups was not significance. CONCLUSIONS In contrast to the decrease in the gastric pH as the PaCO2 and PETCO2 increased in group C, the gastric pH in group E remained high until the end of the surgery despite the increase in the PaCO2 and PETCO2. Esomeprazole premedication seem to have an effect for inhibiting the gastric pH decrement regardless of the increase in the PaCO2 and PETCO2 during laparoscopic surgery.
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Affiliation(s)
- Seung Il Lee
- Department of Anesthesiology and Pain Medicine, School of Medicine, Kyung Hee University, Seoul, Korea.
| | - Young Kyoo Choi
- Department of Anesthesiology and Pain Medicine, School of Medicine, Kyung Hee University, Seoul, Korea.
| | - Wha Ja Kang
- Department of Anesthesiology and Pain Medicine, School of Medicine, Kyung Hee University, Seoul, Korea.
| | - Sung Wook Park
- Department of Anesthesiology and Pain Medicine, School of Medicine, Kyung Hee University, Seoul, Korea.
| | - Jae Woo Yi
- Department of Anesthesiology and Pain Medicine, School of Medicine, Kyung Hee University, Seoul, Korea.
| | - Joon Kyung Sung
- Department of Anesthesiology and Pain Medicine, School of Medicine, Kyung Hee University, Seoul, Korea.
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20
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Weir K, McMahon S, Barry L, Ware R, Masters IB, Chang AB. Oropharyngeal aspiration and pneumonia in children. Pediatr Pulmonol 2007; 42:1024-31. [PMID: 17893917 DOI: 10.1002/ppul.20687] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Oropharyngeal aspiration (OPA) of food and fluids is known to be associated with pneumonia in dysphagic children with neurological disease and direct causality is often assumed. However, little is known about the relationship between OPA and pneumonia in medically complex children when other possible risk factors for pneumonia are considered. We examined the association of World Health Organization (WHO)-defined pneumonia in a heterogeneous group of children with swallowing dysfunction identified by a videofluoroscopic swallow study (VFSS). A retrospective chart review of 150 children (aged 2 weeks to 20 years) was undertaken to determine the relationship between pneumonia and (i) type of swallowing dysfunction (including OPA), (ii) consistency of aspirated food/fluid, and (iii) other factors including multisystem involvement and age (<or=1 year or >1 year). In univariate analysis, the odds ratio (OR) for pneumonia was significantly increased in children with post-swallow residue (PSR) (OR 2.5) or aspiration on thin fluids (OR 2.4), but not with aspiration of thick fluids or purees. In multi-logistic regression, type of swallowing dysfunction or aspirated food/fluid were no longer significant. Instead, pneumonia was significantly associated with diagnosis of asthma (OR 13.25), Down syndrome (OR 22.10), gastroesophageal reflux disease (GERD) (OR 4.28), or history of LRTI (OR 8.28), moist cough (OR 9.17) or oxygen supplementation (OR 6.19). Children with multisystem involvement demonstrated a higher association with pneumonia, but no difference was found for age. We conclude that the impact of OPA on development of pneumonia is considerably reduced once other factors in children with multisystem involvement are taken into account.
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Affiliation(s)
- Kelly Weir
- Department of Paediatrics and Child Health, University of Queensland, Herston, Queensland, Australia.
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21
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Mizock BA. Risk of aspiration in patients on enteral nutrition: frequency, relevance, relation to pneumonia, risk factors, and strategies for risk reduction. Curr Gastroenterol Rep 2007; 9:338-44. [PMID: 17883984 DOI: 10.1007/s11894-007-0039-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Upper digestive feeding intolerance, as evidenced by high gastric residual volume and vomiting, is the most common complication among hospitalized patients receiving enteral nutrition. These patients are at high risk of developing aspiration pneumonia, which in turn is associated with prolonged hospital stay and increased mortality. Most episodes of aspiration are small in volume and do not lead to pneumonia. The likelihood of pneumonia increases with multiple aspirations. Pneumonia is also more common in critically ill patients who have bacterial colonization of the oropharynx. Gastric residual volume is commonly used as a means to assess aspiration risk during tube feeding. However, recent studies have demonstrated that this measurement has limited sensitivity. The approach to minimizing the frequency of aspiration during tube feeding involves assessment of the patient's degree of risk and initiation of appropriate measures directed at risk reduction.
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Affiliation(s)
- Barry A Mizock
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, John Stroger Hospital of Cook County, 1900 West Polk Street, Chicago, IL 60612, USA.
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22
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Strickland A, Brogan A, Krauss J, Martindale R, Cresci G. Is the use of specialized nutritional formulations a cost-effective strategy? A national database evaluation. JPEN J Parenter Enteral Nutr 2005; 29:S81-91. [PMID: 15709550 DOI: 10.1177/01486071050290s1s81] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND We apply currently published clinical outcomes data to length of stay and hospital cost to determine the potential economic benefit associated with the use of specialized nutritional formulations in elective surgical, trauma, and medical patients. Although the use of immune-modulating formulations has repeatedly shown favorable clinical outcomes, including decreased complications (both infectious and noninfectious), length of stay (both ICU and total days), and ventilator days, the cost-effectiveness of nutritional modulation of the immune response in a US-based population has not previously been explored. METHODS Data for the current study were obtained from a large national database with 126 member hospitals and data from over 1 million patients. Data extracted from the database included patient type (surgical, medical, and trauma) and subservice, whether the hospital stay was "complicated" or "uncomplicated" (as determined by diagnosis-related groups and International Classification of Diseases, Ninth Revision coding), mean length of stay, mean cost, and incremental cost per complication experienced. The clinical outcomes measures from 3 major peer-reviewed studies were then applied to the cost data in order to determine the cost savings associated with the use of specialized nutritional formulations in each of the patient populations. Additionally, cost data were segmented by region of the United States (New England, mid-Atlantic, South, Midwest, Southwest, and West) and by primary focus of the health care facility (academic, indigent care, large community) to enable more meaningful cost comparisons. RESULTS For the medical patient population, according to the published rate of 51% decrease in risk of infectious complications and a decreased length of hospital stay of 9.7 days, net cost savings (after accounting for the increased costs of administering immune modulating formula) is $2066. The same calculations were done for surgical and trauma patients, with $688 and $308 net cost savings per patient, respectively. These figures assume a base infection rate of 5%. Expected cost savings vary markedly for deviations in base infection rate and slightly for differences in facility type or region of the country. CONCLUSIONS This study demonstrates that specialized nutritional formulations are a cost-effective way for hospitals to improve clinical outcomes while reducing resource consumption and total cost. These benefits are observable in all patient types, all facility types, and all regions of the United States.
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Affiliation(s)
- Adrien Strickland
- Department of Surgery, Medical College of Georgia, Augusta, Georgia, USA.
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23
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Malone AM, Brewer CK. Monitoring for Efficacy, Complications, and Toxicity. Clin Nutr 2005. [DOI: 10.1016/b978-0-7216-0379-7.50027-9] [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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24
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Clohessy S, Roth JL. Administration of Enteral Nutrition: Initiation, Progression, and Transition. Clin Nutr 2005. [DOI: 10.1016/b978-0-7216-0379-7.50024-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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25
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Gomes GF, Campos AC, Pisani JC, Macedo ED, Vieira MC. Diagnostic methods for the detection of anterograde aspiration in enterally fed patients. Curr Opin Clin Nutr Metab Care 2004; 7:285-92. [PMID: 15075920 DOI: 10.1097/00075197-200405000-00008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The diagnosis of aspiration and its origin in patients on enteral tube feeding is challenging to the physician and provides an important means to prevent pneumonia. This review examines the most recent studies and developments in the field with an approach to the technical aspects of diagnostic methods. RECENT FINDINGS The methods more commonly used to detect anterograde aspiration in clinical practice are fiberoptic endoscopic evaluation of swallowing and modified barium swallowing. Recent studies have shown that although these methods may provide the diagnosis of aspiration, their use for clinical monitoring is not appropriate. The studies comparing fiberoptic endoscopic evaluation of swallowing and modified barium swallowing have demonstrated that both tests present similar sensitivity, specificity and predictive values. SUMMARY The different methods used to diagnose anterograde aspiration are appropriate for clinical practice, with a low complication rate and few contraindications. In most instances, the early diagnosis of aspiration and evaluation of other factors such as laryngeal sensibility, may predict the occurrence of aspiration pneumonia.
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Affiliation(s)
- Guilherme F Gomes
- Department of Gastroenterology, Federal University of Parana and Hospital Nossa Senhora das Graças, Curitiba, Brazil
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