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At least 325 records · Page 18Linked to original sources

PubMed1996

Aspiration and sclerotherapy of symptomatic simple renal cysts: value of two injections of a sclerosing agent.

OBJECTIVE: The purpose of our study was to determine whether two injections of sclerosant were more effective than a single injection in treating symptomatic simple renal cysts. SUBJECTS AND METHODS: We reviewed our results obtained by simple aspiration, by aspiration and a single sclerosant injection, and by aspiration followed by two injections of sclerosing agent over 48 hr. We used 95% alcohol because of its capacity to safely sclerose the epithelial lining of renal cyst walls without damaging the renal parenchyma. After 1-3 min of contact with the alcohol, the epithelial cells lining the cyst become fixed and nonviable; the cyst capsule is penetrated only after 4-12 hr. Longer contact of alcohol with the epithelial cell lining should theoretically result in the nonviability of more epithelial cells and therefore in a lower recurrence rate of cysts after aspiration and sclerotherapy. Our subjects were 46 patients, 30 men and 16 women, treated over a 13-year period. They ranged in age from 38 to 75 years old (mean age, 47 years). Fifty-two cysts were treated. Twenty patients (20 cysts) had simple aspiration only, 15 patients (19 cysts) had a single injection of sclerosant after aspiration, and 11 patients (13 cysts) had two sclerosant injections after aspiration. RESULTS: Of the 20 patients who had simple aspiration only, 16 cysts had recurred after 2 years. In the single-injection group of patients, we found six recurrences after 2 years. No recurrence has occurred in the group of patients who had two sclerosant injections after aspiration. CONCLUSION: Our findings suggest that the results of treating symptomatic simple renal cysts are better in terms of recurrence with two successive injections of 95% alcohol, probably because of the nonviability of more epithelial cells lining the cyst as a result of a longer period of contact with the alcohol. Our sonographic finding of pseudotumors at the sites of previously aspirated giant cysts in two patients is recorded.

Combined Modality Therapy↗

PubMed2004

Percutaneous cholecystostomy versus gallbladder aspiration for acute cholecystitis: a prospective randomized controlled trial.

OBJECTIVE: This study was performed to determine and compare the effectiveness and incidence of complications of percutaneous cholecystostomy and gallbladder aspiration in cases of severe acute cholecystitis. SUBJECTS AND METHODS. Fifty-eight patients with severe acute cholecystitis who did not improve after antibiotic treatment were included in this study. The patients were randomized into either the percutaneous cholecystostomy group (n = 30) or the gallbladder aspiration group (n = 28). Under sonographic guidance, percutaneous cholecystostomy was performed in the usual manner using a 6.5- or 7-French catheter. Gallbladder aspiration was carried out with a 21-gauge needle under sonographic guidance. The technical success, clinical response, and complications in each group were evaluated. RESULTS: Percutaneous cholecystostomy and gallbladder aspiration were technically successful in 30 patients (100%) and 23 patients (82%), respectively (not statistically significant). In five patients (18%) of the gallbladder aspiration group, aspiration was unsuccessful because of replacement of bile with dense biliary sludge or pus. Good clinical response was obtained in 27 patients (90%) of the percutaneous cholecystostomy group and in 14 patients (61%) of the gallbladder aspiration group (p < 0.05). As for complications, dislodgment of the catheter occurred in one patient of the percutaneous cholecystostomy group and minor bleeding in one patient after gallbladder aspiration. No major complications or procedure-related deaths occurred in either group. CONCLUSION: For severe acute cholecystitis, percutaneous cholecystostomy was superior to gallbladder aspiration in terms of clinical effectiveness and had the same complication rate as gallbladder aspiration.

Acute Disease↗

PubMed2000

Evaluation of nasotracheal aspiration as a diagnostic tool for Rhodococcus equi pneumonia in foals.

The reliability of preparing bacteriological cultures from nasotracheal aspirates of foals routinely in order to diagnose R. equi pneumonia in foals was studied by isolating Rhodococcus equi from specimens obtained from 96 foals by nasotracheal aspiration with a silicon catheter. Results were compared with specimens obtained from 21 foals by transtracheal aspiration (percutaneous tracheal puncture). These 117 foals showed clinical signs of respiratory tract infection at sampling. R. equi was isolated from 14 of 21 (66.7%) specimens by transtracheal aspiration and from 59 of 96 (61.4%) specimens by nasotracheal aspiration, 649 of 655 isolates (99.1%) from the 73 positive specimens were virulent R. equi, and the culture-positive foals were diagnosed as having R. equi pneumonia. To assess the contamination of aspirates by organisms from the nasopharynx, the results of R. equi isolation from nasal swabs obtained from 56 of the 96 foals were compared to those obtained by nasotracheal aspiration from the same foals. R. equi was isolated from 2 of the 56 nasal swabs: one from a tracheal aspirate was positive, and the other was not. These results suggest that the nasotracheal aspiration technique, which is noninvasive and not associated with complications, could be used as an alternative to the transtracheal aspiration method, especially for the diagnosis of R. equi pneumonia in foals.

Actinomycetales Infections↗

PubMed2002

Utility of subcutaneous fat aspiration for diagnosing amyloidosis in patients with isolated peripheral neuropathy.

OBJECTIVE: To determine the value of subcutaneous fat aspiration in patients with sensorimotor peripheral neuropathy. PATIENTS AND METHODS: We retrospectively reviewed the medical records of all patients undergoing subcutaneous fat aspiration for suspected amyloidosis from January 1, 1994, through December 31,1999. We classified patients undergoing subcutaneous fat aspiration due to peripheral neuropathy into 2 groups: (A) those with isolated peripheral neuropathy and (B) those with any family history and laboratory or clinical findings typically associated with systemic amyloidosis. RESULTS: The study population consisted of 450 patients with peripheral neuropathy in whom fat aspiration was performed for suspected amyloidosis. This constituted 56% of all fat aspirations performed during the study period. Group A had 143 patients, and group B had 307 patients. None of the patients in group A had a positive subcutaneous fat aspirate, whereas 17 patients (6%) in group B had a positive subcutaneous fat aspirate (P=.002, Fisher exact test). The subcutaneous fat aspirate was most commonly positive in patients with a monoclonal protein or other clinical findings associated with amyloidosis. CONCLUSIONS: The yield of a subcutaneous fat aspirate in patients with isolated peripheral neuropathy and no other associated family history, signs, or symptoms of amyloidosis is low. Subcutaneous fat aspiration should be reserved for evaluating patients with peripheral neuropathy who also have findings associated with systemic amyloidosis.

Adipose Tissue↗

PubMed2000

Soft tissue aspiration cytopathology.

BACKGROUND: Fine-needle aspiration (FNA) biopsy as a diagnostic modality for the pathologic evaluation of soft tissue neoplasms and non-neoplastic soft tissue mass lesions is uncommon and controversial. This procedure contrasts with more traditional diagnostic methods such as marginal excision, incisional (open) biopsy, or even core biopsy to procure tissue from somatic sites. METHODS: The authors reviewed the results of cytopathologic diagnoses obtained by fine-needle aspiration biopsy over a consecutive 11-month period in patients that presented primarily with a palpable soft tissue mass. A few patients with deep non-palpable soft tissue masses also were evaluated by radiologically guided FNA. Cytopathologic diagnoses were verified by different means including tissue examination either by concurrent cell block or subsequent surgical biopsy, flow cytometry, clinical outcome, or repetition of the FNA procedure. Patients were followed for a minimum of one year to evaluate the mass clinically, to determine whether any further therapy was administered, and to assess disease status. RESULTS: Eighty-two aspirates were performed without complications from 77 patients ranging from 12-88 years of age (mean = 50 yrs.) with men outnumbering women 1.5:1. Soft tissue masses were most common in the extremities (41 cases), followed by the trunk (34 cases), retroperitoneum (5 cases), and head and neck (2 cases). Fine-needle aspirates were diagnosed as malignant in 42 (51%), benign in 32 (39%), nondiagnostic in 6 (7%), and atypical in 2 (2%) cases. Malignant aspirates were comprised of 24 sarcomas (57%), 9 carcinomas (21%), 6 malignant lymphomas (14%), and 3 melanomas (7%). Twenty-two aspirates (52%) had an initial diagnosis of malignancy, whereas 18 (43%) represented metastatic and 2 (5%) recurrent neoplasms. Confirmation of the cytopathologic diagnosis was by concurrent or subsequent tissue examination in 57%, flow cytometry in 5%, clinical outcome in 34%, and repeat aspiration in 4%. One false negative and no false positive diagnoses were issued for a sensitivity and specificity of 100% and 97% respectively in distinguishing benign and malignant lesions by FNA. Of the malignant aspirates, 83% could be subtyped whereas 72% of benign aspirates were correctly subtyped. For primary soft tissue sarcomas, 12 of 19 (63%) were accurately subtyped. In 48% of cases a concurrent cell block was obtained and found diagnostically useful in 54% of them. CONCLUSIONS: Aspiration cytopathology of soft tissue mass lesions using FNA biopsy can be an accurate and minimally invasive method for the initial pathologic diagnosis of primary benign and malignant soft tissue masses, for the pathologic confirmation of metastatic tumors to soft tissue, and for the documentation of locally recurrent soft tissue neoplasms. FNA cytopathology is capable of specifically subtyping a large percentage of primary and metastatic soft tissue tumors if cellular material either in the form of a cell block or flow cytometry is obtained in addition to cell smears.

Adolescent↗

PubMed2004

[Is pulse oximetry a reliable tool for detection of aspiration?].

This study was designed to determine whether significant differences in saturation levels existed among patients with aspiration and patients without and wether pulse oximetry can reliably detect aspiration in patients with dysphagia. We also examined the effects of gender and disease (neurologic versus non neurologic) on saturation levels. We studied 38 patients. They all underwent a videofluoroscopic study of swallowing (VFSS). Twenty patients aspirated on videofluoroscopic study of swallowing: ten patients were solid aspirators, ten patients were liquid aspirators. In each group (liquid aspirators, solid aspirators or non aspirators) we found no significant difference in saturation levels. We found however a significant difference in saturation levels between each group before, during and after videofluoroscopic study of swallowing. Both gender and disease had an effect on saturation levels. We conclude that pulse oximetry can not serve as a screening tool for detection of aspiration as saturation levels are dependent on many factors. Therefore one can not reliably predict aspiration with a single saturation screening.

Aged↗

PubMed1987

Fine needle aspiration cytology of breast masses: an evaluation of its accuracy and reasons for diagnostic failure.

A study of 1458 patients who had undergone breast aspiration cytology was conducted to determine the diagnostic accuracy of the technique. The effect of tumour histology and size on the unsatisfactory aspirate and false negative rate was examined. Seven hundred and thirty one patients (50%) had histological diagnoses. The sensitivity of aspiration cytology for malignancy was 64% for the first aspiration, but was 91% in patients who had had 3 aspirates. The specificity was 56%, this low figure was almost entirely due to inadequate or unsatisfactory cytological preparations. The positive and negative predictive values of aspiration cytology were 99.4% and 85% respectively demonstrating high diagnostic accuracy given a satisfactory aspirate. Invasive lobular carcinoma yielded a significantly higher unsatisfactory rate than invasive ductal carcinoma (P less than 0.001) and fibroadenoma yielded a significantly lower unsatisfactory rate than fibroadenosis (P less than 0.001). Mass size influenced the unsatisfactory rate for invasive ductal carcinoma (P less than 0.05) and fibroadenoma, but not for invasive lobular carcinoma or fibroadenosis. Only 2 of the 32 false negatives were due to misinterpretation, the remainder resulted from the aspiration needle missing the mass. We conclude that aspiration cytology is an accurate preoperative diagnostic procedure for the evaluation of breast masses. Unsatisfactory or negative aspirates should be regarded as 'non-results' if there is clinical or radiological suspicion of malignancy.

Adolescent↗

PubMed1997

The Coventry Award. The value of preoperative aspiration before total knee revision.

The value of routine aspiration of a symptomatic total knee replacement before reoperation was evaluated. The study group consisted of a consecutive series of 69 knees in 67 patients in which preoperative aspiration was performed. All aspirations were performed on an outpatient basis in a clinic setting. Local anesthetics and saline washings were not used. Twenty knees were determined to be infected and 49 knees were not infected. Preoperative aspiration had an overall sensitivity of 55%, specificity of 96%, accuracy of 84%, positive predictive value of 85%, and negative predictive value of 84%. Sixteen patients were taking antibiotics at the time of referral including 12 of 20 (60%) who had infected knees. Seven of these 12 (58%) had no growth on their initial knee aspiration. Four of these had their knees reaspirated at a later date because of a high index of suspicion for infection and the subsequent aspiration revealed the infecting organism in all four cases. Two of the remaining three patients had signs of sepsis develop and reaspiration was not performed because immediate reoperation was indicated clinically. The initial aspiration on the third patient was performed after antibiotic therapy was discontinued for 4 weeks and a repeat aspiration was not deemed necessary. When the results of the reaspirations are included, the overall aspiration results improved to a sensitivity of 75%, specificity of 96%, and accuracy of 90%. The results of the study support the use of routine preoperative aspiration before total knee revision. Previous antibiotic use increases the risk of a false negative result, and reaspiration at a later date can be expected to significantly improve the value of this test in such cases.

Aged↗

PubMed2002

Immunocytochemical detection of milk proteins in tracheal aspirates of ventilated infants: a pilot study.

In this study, we evaluated immunocytochemical staining for milk proteins (alpha-lactalbumin and beta-lactoglobulin) in tracheal aspirates of mechanically ventilated infants, and assessed whether this staining technique supported a clinical diagnosis of aspiration in infants receiving orogastric feedings. All newborns requiring mechanical ventilation in the neonatal intensive care unit of a major tertiary care hospital were potential subjects for this study. Tracheal aspirates were obtained prior to the introduction of enteral feeding and at various time points thereafter in newborns requiring mechanical ventilation. Cells were obtained and processed for immunocytochemical staining of alpha-lactalbumin and beta-lactoglobulin. In total, 88 specimens recovered from 34 infants were adequate for staining. Alveolar macrophages recovered from most of the infants who were never fed (true negative controls) did not display immunoreactivity for milk proteins: 4/34 or 12% of infants' aspirates demonstrated presence of milk proteins before enteral feeding was commenced. Tracheal aspirates obtained from 12 infants after introduction of enteral feedings appeared to support clinical and radiological findings suggestive of aspiration events, with positive immunostaining on several occasions. These observations support our work in a murine model and demonstrate that immunocytochemical staining of tracheal aspirates for milk proteins may enhance the ability to diagnose pulmonary aspiration. Further studies are needed to define the clinical significance of our findings and the effects of single and repeated aspiration events on respiratory status.

Female↗

PubMed2000

Prevalence of aspiration and laryngeal penetration in patients with unilateral vocal fold motion impairment.

The adverse consequences of aspiration in regard to patient health and quality of life are well documented. It is generally accepted that the probability of aspiration is increased in patients with unilateral vocal fold motion impairment, however, the incidence and proposed mechanism of aspiration vary depending on the reported series. We reviewed the cine or video pharyngoesophagographic findings in patients with documented unilateral vocal fold motion impairment, identified through the Johns Hopkins Hospital Swallowing Center database, to determine the prevalence and cause of aspiration and laryngeal penetration. Aspiration and laryngeal penetration were identified in 38% and 12% of patients, respectively. Aspiration resulted from impaired airway protection, not from esophageal obstruction with laryngeal "spill-over." The number and degree of impairments directly correlated with probability of aspiration. Obstruction potentiated the likelihood of aspiration. Video pharyngoesophagography accurately identifies patients at risk for aspiration.

Adult↗

PubMed1992

The prevention and treatment of aspiration of vomitus during pharmacosedation and general anesthesia.

The aspiration of gastric contents can occur in patients with a depressed level of consciousness. Pulmonary aspiration is a serious potential complication of pharmacosedation and general anesthesia. Sequelae associated with aspiration include pulmonary obstruction, chemical pneumonitis, secondary infection, and possibly death. Morbidity following aspiration is enhanced with an increased volume of aspirate, a more acidic pH, a high particle content, and bacterial contamination. Treatment of aspiration is dependent on the nature of the aspirate. Identifying aspiration-susceptible patients, employing preventive measures, and using careful anesthetic technique can effectively reduce the risk of aspiration.

Anesthesia, General↗

PubMed2006

Increased risk of aspiration and pulmonary complications after lung resection in head and neck cancer patients.

BACKGROUND: Patients with head and neck cancers (HNCs) may have impaired deglutition and airway protection. The risk of pulmonary complications after lung resection has not been evaluated in HNC patients. We therefore reviewed the risk of aspiration-related pulmonary complications in HNC patients after pulmonary resection. METHODS: Retrospective review of a prospectively collected database from a single institution identified 1633 patients who underwent pulmonary resection for suspected primary lung cancer from 1997 to 2004. Of these, 76 patients had a history of HNC. The remaining 1557 patients were defined as controls. Categoric variables were analyzed with the chi2 test. Univariate and multivariate logistic regression analyses determined the variables related to aspiration pneumonia after pulmonary resection. RESULTS: Aspiration pneumonia occurred in 7 HNC patients (9.2%) versus 10 patients (0.6%) in the control group (p < 0.001). In the entire population with pulmonary resection, HNC history (p < 0.001; odds ratio (OR), 17.5; 95% confidence interval (CI), 6.0 to 50.6), and postoperative recurrent laryngeal nerve paralysis (p < 0.001; OR, 27.8; 95% CI, 5.2 to 148) were independent risk factors for aspiration pneumonia after pulmonary resection. Length of stay was longer in patients with aspiration pneumonia, with a median of 30 days (range, 10 to 258) versus 6 days (range, 0 to 374; p = 0.021). In the HNC patients, prior recurrent laryngeal nerve paralysis was predictive of aspiration pneumonia (p = 0.034; OR, 8.8; 95% CI, 1.1 to 65.4). CONCLUSIONS: Patients with HNC have an increased risk of aspiration pneumonia after pulmonary resection. Evaluation of swallowing function to identify aspiration is indicated in HNC patients before pulmonary resection to avoid the morbidity and prolonged hospitalization associated with aspiration pneumonia.

Adult↗

PubMed2006

Management of pulmonary aspiration.

Pulmonary aspiration of gastric contents in the perioperative phase is associated with increased postoperative morbidity and mortality. For the management of aspiration, differentiation between acid-associated aspiration pneumonitis and aspiration pneumonia as a consequence of a secondary bacterial contamination is of crucial importance. The incidence of aspiration in elective surgery is 1 per 2000-3000 anaesthesias in adults. In children, it is slightly more common with 1 per 1200-2600 anaesthesias. In the context of emergency anaesthesias the incidence of aspiration is three to four times higher. The risk particularly increases with recent ingestion of solid food or fluids, with older patients, with pregnant women, and with consciousness-reduced patients. Besides giving a review of the pathophysiology, incidence, and the risk factors of aspiration, this article places emphasis on the practical management of this anaesthesia-associated complication. Cricoid pressure, as a non-evidence-based but clinically wide-spread method in the context of the prophylaxis of aspiration, is discussed critically. The main part deals with strategies to structure the management of aspiration by use of scientific concepts based on medical crisis management. For this, an algorithm based on current scientific investigations is presented.

Acupressure↗

PubMed1992

Does DeLee suction at the perineum prevent meconium aspiration syndrome?

OBJECTIVE: We attempted to determine the impact of "early" (before delivery of the chest) oronasopharyngeal DeLee suctioning at the perineum in the prevention of meconium aspiration syndrome and to confirm that meconium aspiration syndrome is a postnatal event. STUDY DESIGN: We compared infants with meconium-stained fluid who underwent "early" oronasopharyngeal DeLee suctioning with a similar group of infants whose airways were suctioned "late" (after chest delivery). Practicing obstetricians did not know the study was being conducted by the pediatric staff, and an independent observer documented whether obstetricians performed "early" or "late" oronasopharyngeal DeLee suctioning. Immediate postnatal tracheal suctioning was performed in both groups. The study was conducted in a private tertiary care center averaging 5800 deliveries annually. A consecutive sample of 438 infants with meconium-stained fluid was analyzed. Of these infants, 221 received "early" oronasopharyngeal DeLee suctioning, while 217 infants were suctioned "late". RESULTS: Of the 438 infants with meconium-stained fluid, meconium aspiration syndrome developed in 38 (9%). These infants had higher rates of fetal distress (i.e., abnormal fetal heart rates) and lower Apgar scores (< or = 6) than infants without meconium aspiration syndrome (58% vs 17% and 65% vs 13%, respectively; p < 0.001). Forty-five percent of the infants with meconium aspiration syndrome had renal failure during the first 20 hours of life. In spite of "early" oronasopharyngeal DeLee suctioning, 53% of the infants in this group had meconium below the vocal cords and meconium aspiration syndrome developed in 7%. The time of oronasopharyngeal DeLee suctioning did not affect the rate of meconium aspiration syndrome or the presence of meconium below the vocal cords. CONCLUSIONS: We concluded that "early" oronasopharyngeal DeLee suctioning at the perineum does not affect the rate of meconium aspiration syndrome. We speculate that meconium aspiration syndrome is predominantly an intrauterine event associated with fetal distress and that meconium in the airways is merely a "marker" of previous fetal hypoxia.

Chi-Square Distribution↗

PubMed2000

Oropharyngeal dysphagia and aspiration in patients with ataxia-telangiectasia.

OBJECTIVES: To determine whether patients with ataxia-telangiectasia exhibit oropharyngeal dysphagia with concomitant aspiration and to examine the relationships among swallowing function, age, and nutritional status. STUDY DESIGN: Seventy patients (mean age, 10.7 years; range, 1.8 to 30 years) had feeding/swallowing and nutritional evaluations. Fifty-one patients, in whom there were concerns about swallowing safety, were examined with a standardized videofluoroscopic swallow study. RESULTS: Fourteen of the 51 patients (27%) with histories suggestive of dysphagia demonstrated aspiration. Of these, silent aspiration (aspiration without a cough) occurred in 10 (71%) patients. Aspirators were significantly older than non-aspirators (mean age, 16.9 vs 10.8 years; P =.002). Advancing age was the strongest factor associated with aspiration during continuous drinking (P =.01). In patients with ataxia-telangiectasia, weight and weight/height were abnormally low at all ages and most compromised in older patients. Patients who aspirated had significantly lower mean weight (P <.002) and weight/height z scores (P <.001) than did patients who did not aspirate. CONCLUSIONS: Oropharyngeal dysphagia is common and appears to be progressive in patients with ataxia-telangiectasia. Older patients also have a higher incidence of poorer nutritional status. The relationship between dysphagia and nutritional status deserves further investigation.

Age Factors↗

PubMed1998

Pulmonary aspiration in pediatric patients during general anesthesia: incidence and outcome.

STUDY OBJECTIVES: To determine the incidence of, outcome of, and risk factors for anesthesia-related pulmonary aspiration in the predominantly pediatric population receiving anesthesia care. DESIGN: Using a clinical concurrent quality assessment system we developed, we used data stored in a custom-designed computerized database to initiate a retrospective review. Statistical relationships were analyzed by Fisher's exact test and binary logistic regression with commercially available software. SETTING: University-affiliated pediatric hospital. PATIENTS: All patients receiving anesthesia (n = 50,880) between April 1, 1988, and March 31, 1993. MEASUREMENTS AND MAIN RESULTS: Aspiration occurred in 52 (0.10% or 10.2 per 10,000) of the 50,880 general anesthesia cases. Aspirate was food or gastric contents in 25 cases (0.049% or 4.9 per 10,000), blood in 13 (0.026% or 2.6 per 10,000), and unknown material in 14 (0.0275% or 2.76 per 10,000). There were no deaths attributable to aspiration. Morbidity was confined to unanticipated hospital admission (n = 12), cancellation of the surgical procedure (n = 4), and intubation, with or without ventilation (n = 15). Aspiration occurred significantly more often in patients with greater severity of underlying illness (ASA physical status III or IV) (p = 0.0015), intravenous induction (p = 0.0054), and age equal to or greater than 6.0 years and less than 11.0 years (p = 0.0029). Emergency procedures had a marginally significant increased aspiration risk (p = 0.0527). CONCLUSIONS: The overall incidence of anesthesia-related aspiration in our series (0.10%) was twice that reported in studies of adults, and four times (0.25%) higher for those at highest risk (ASA physical status III or IV vs. physical status I or II). Anesthesia-related pulmonary aspiration was proven to be a rare event in this tertiary pediatric center and its consequences relatively mild. Because of the very low frequency and the lack of serious outcome after aspiration in ASA physical status I and II pediatric patients, it appears that routine prophylactic administration of histamine blockers or propulsive drugs in healthy pediatric patients is unwarranted.

Adolescent↗

PubMed1979

Antacid pulmonary aspiration in the dog.

The amount of damage resulting from pulmonary aspiration of gastric contents is determined primarily by the acidity of the aspirate. Thus, it has been recommended that the pH of stomach contents of pregnant women be increased by the oral administration of antacids prior to anesthesia for delivery. This study was done to investigate the effects of antacid aspiration in dogs and compare these effects with those obtained by trials of aspiration of acid, saline solution, and alkaline saline solution. Mean PaO2 of the saline-treated group had decreased from 81 to 60 torr at 10 min, while that of the alkaline saline-treated group had decreased from 83 to 58 torr. Fractional intrapulmonary physiologic shunt (Qs/Qt) increased in these two groups, from 15 to 34 and from 16 to 42 per cent, respectively. The Qs/Qt had returned to control values in both groups by four hours, and the PaO2 had returned to control values by 24 hours. By contrast, the acid- and antacid-treated groups had decreases in PaO2 values from 77 to 34 torr and from 84 to 46 torr, respectively. Neither group had a return of PaO2 to pre-aspiration level by 24 hours. Likewise, the Qs/Qt increased significantly more in these two groups: 14 to 66 per cent in the acid-treated group and 13 to 47 per cent in the antacid-treated group. These changes persisted throughout four hours. The saline and alkaline saline aspirates produced little histologic damage. The acid aspirate produced hemorrhage, exudates, and edema. However, these changes were no longer present a month later. The antacid aspirate produced a marked bronchopneumonia that was still present as a chronic inflammatory reaction after a month. These findings indicate that antacids can cause pulmonary damage when aspirated.

Animals↗

PubMed1990

Acute histologic effects of simulated large-volume aspiration of sucralfate into the lungs of rats.

Sucralfate is an effective agent in reducing the incidence of upper GI tract (UGIT) stress bleeding and nosocomial pneumonia in critically ill patients. Many of these patients are not intubated and are at increased risk for aspiration of large volumes of UGIT contents containing sucralfate. The effects of aspirated sucralfate are unknown. To investigate this, large-volume aspiration (2 ml/kg) was simulated in freshly tracheostomized rats (n = 6, all experimental groups) using normal saline, particulate antacid, and sucralfate adjusted to pH 3.6 and 5.0. Four hours after aspiration, the rats were killed and their lungs were formalin-fixed. Significant increases in lung inflammation were seen by light microscopy in all experimental groups at pH 3.6. Antacid aspirated at pH 5.0 induced significant increases in airway as well as parenchymal inflammation. At pH 3.6, the antacid aspiration led to significant increases in lung edema and hemorrhage. Sucralfate aspiration produced significant increases in pulmonary hemorrhage at pH 5.0. Our microscopic findings are consistent with the acute pulmonary histopathologic changes known to occur after large-volume aspiration of particulate materials, including antacids. Additionally, we show that large-volume aspiration of sucralfate produced significant acute pneumonitis, including pulmonary hemorrhage. In view of the proven usefulness of sucralfate, further investigations are indicated to evaluate these experimental findings before extrapolating to critically ill patients.

Aluminum Hydroxide↗