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At least 541 records · Page 30Linked to original sources

PubMed2000

Preemptive gastrointestinal tract management reduces aspiration and respiratory failure after thoracic operations.

OBJECTIVES: Respiratory failure is the major mode of death after general thoracic operations. However, respiratory failure may develop from two very different mechanisms: aspiration, often caused by ileus, and pneumonia, which often results from poor pain control. Epidural catheters help control pain and prevent pneumonia but contribute to ileus and may increase aspiration. We report a decrease in the incidence of aspiration after changing postoperative care to include gastrointestinal tract management. METHODS: All patients undergoing elective thoracotomy by a single surgeon were evaluated for hospital mortality and morbidity. For the first 21 months, patients did not receive an intraoperative nasogastric tube and were prescribed an "advance as tolerated" diet after the operation (n = 125). For the second period, nasogastric tubes were placed intraoperatively and patients received nothing by mouth the day of operation, clear liquids the first day, and a regular diet the second day (n = 153). Pneumonia was considered to have developed if infiltrates developed in a single lobe or two adjoining lobes and culture of the sputa grew a dominant organism. Patients were considered to have aspirated if diffuse infiltrates developed or cultures grew multiple organisms. Significance of results was determined by chi(2) testing. RESULTS: A total of 278 patients underwent elective lung resection over a 3(1/2)-year period, 125 with ad libitum dietary management and 153 with intensive management of the gastrointestinal tract. Six patients (4.84%) aspirated before the institution of gastrointestinal tract management, whereas none (0.0%) aspirated after the change. This difference was significant (P =.01). Respiratory mortality was eliminated in the group with gastrointestinal tract management (P =.04). CONCLUSIONS: Aspiration and its subsequent respiratory failure and mortality can be decreased with preemptive gastrointestinal tract management.

Diet↗

PubMed2005

Agreement of aspiration tests using barium videofluoroscopy, salivagram, and milk scan in children with cerebral palsy.

To study the agreement between three tests for aspiration, barium videofluoroscopy, salivagram, and milk scan we studied 63 children with severe non-ambulant spastic quadriplegic cerebral palsy (CP) aged 14 months to 16 years (32 males, 31 females). The salivagram was most frequently positive (56%, 95% confidence interval 43 to 68%); the next most frequently positive was barium videofluoroscopy when aspiration was defined as the presence of either laryngeal penetration of material or frank aspiration (39%, 95% confidence interval 26 to 53%). The milk scan was rarely positive (6%, 95% confidence interval 2 to 16%). Agreement between the tests of aspiration was poor. The maximum agreement (kappa=0.20) was between aspiration as diagnosed with the salivagram and by barium videofluoroscopy. Positive tests for aspiration are frequent in children with severe CP. Frequency varies widely depending on the investigation used. There is poor agreement between tests used for the diagnosis of aspiration. This information is of importance in assessing the significance of test results.

Adolescent↗

PubMed2000

Detection of aspiration and swallowing disorder in older stroke patients: simple swallowing provocation test versus water swallowing test.

OBJECTIVE: To assess the sensitivity and specificity of a simple swallowing provocation test (SPT) and a water swallowing test (WST) in detecting aspiration pneumonia in elderly patients with stroke. DESIGN: Retrospective comparative study involving a simple 2-step SPT and WST on all subjects. PARTICIPANTS: Twenty-six stroke patients with aspiration pneumonia (mean age, 72.1 +/- 4.1 yr) and 26 age-matched stroke patients without aspiration pneumonia (mean age, 69.4 +/- 3.9 yr). INTERVENTIONS: The normal response to SPT was determined by inducing swallowing reflex within 3 seconds after water injection into the suprapharynx. In WST, subjects drank quantities of 10 and 30 mL of water from a cup within 10 seconds. The subject who drank water without interruption-without evidence of aspiration-was determined as normal. RESULTS: The sensitivity and specificity of first-step SPT for the detection of aspiration pneumonia were 100% and 83.8%, respectively. Those of the second-step SPT were 76.4% and 100%, respectively. The sensitivity and specificity of first-step WST using 10 mL of water for the detection of aspiration pneumonia were 71.4% and 70.8%, respectively. Those of the second-step WST using 30 mL of water were 72% and 70.3%, respectively. CONCLUSION: SPT is more useful than WST in differentiating patients predisposed to aspiration.

Aged↗

PubMed2005

Are educational aspirations associated with the risk of alcohol use and alcohol use-related problems among adolescents?

OBJECTIVE: Using prospective data, we hypothesized that public middle school students with high educational aspirations would report less alcohol use, and alcohol use-related problems in the subsequent year. METHODS: The participants for these analyses included students, ages 11 to 14 years old, participating in a longitudinal study in an urban sample of public schools (n = 1229). As part of the prospective annual assessments of the students, in 1992 (to) and 1993 (t1), data on educational aspirations and on alcohol use, and alcohol use-related problems were gathered. Latent variable modeling was used to assess the relationship between educational aspirations at baseline (to) and subsequent year drinking behavior (t1) in two separate models, one to examine the relationship of educational aspirations with self-reported alcohol use (model 1), and another to examine the association with alcohol use-related problems (model 2). Potential confounding by age, sex, race-ethnicity, alcohol use by peers, self-reported school performance, and neighborhood environment was held constant in each model. In addition, each model took into account the prior year report of alcohol use and alcohol use-related problems, respectively. RESULTS: The evidence indicated that students with high aspirations were no more nor less likely to report subsequent alcohol use [beta = 0.15, 95% confidence interval (CI) = -0.19, 0.49; p = 0.38] nor alcohol use-related problems (beta = -0.009, CI = -0.07, 0.06; p = 0.80). Other characteristics were associated with alcohol use at follow-up and included race-ethnicity (being non-Black), neighborhood environment, and having friends who drink alcohol. Characteristics associated with alcohol use-related problems at the time of the follow-up interview also included race-ethnicity, peer drinking, neighborhood environment, as well as older age. CONCLUSIONS: Findings from the current study do not support the hypothesis that educational aspirations have significant influences on alcohol consumption or drinking problems in this study population of urban, predominantly Black students. As such, this work helps to advance our understanding of suspected relationships between educational aspirations, as well as factors associated with resilience to alcohol use and the occurrence of alcohol use-related problems.

Achievement↗

PubMed2002

Gastroesophageal reflux and tracheal aspiration in the thoracotomy position: should ranitidine premedication be routine?

UNLABELLED: Aspiration of gastric contents may contribute to pulmonary complications after thoracotomy. The incidence of gastroesophageal reflux (GER) and tracheal acid aspiration in patients undergoing thoracotomy in the lateral position is unknown. Ranitidine premedication reduces gastric volume, increases gastric pH, and may reduce GER. We used continuous intraluminal esophageal and tracheal pH monitoring probes to investigate the effect of ranitidine on the incidence of GER and tracheal aspiration in 80 adult patients undergoing thoracotomy. The study was placebo-controlled, randomized, and double-blinded. Patients at high risk of GER were excluded from the study. The incidence of acid GER in the placebo and ranitidine groups was 28.2% and 2.5%, respectively (P = 0.006). Multiple episodes of GER occurred in some patients in the placebo group only. The total number of episodes of GER in the placebo and ranitidine groups was 16 and 1, respectively (P = 0.002). The incidence of tracheal acid aspiration in the placebo and ranitidine groups was 7.7% and 2.5%, respectively (not significant). Patients undergoing thoracotomy are therefore at high risk of acid GER, which may lead to tracheal acid aspiration in an appreciable proportion. Premedication with ranitidine significantly reduces, but does not eliminate, the incidence of this potentially life-threatening complication. IMPLICATIONS: Gastroesophageal reflux (GER) and tracheal aspiration of acid may increase morbidity and mortality in patients undergoing thoracotomy. This randomized, double-blinded, placebo-controlled study demonstrates frequent incidences of both acid GER and tracheal acid aspiration during surgery that are significantly reduced by premedication with ranitidine.

Double-Blind Method↗

PubMed1993

Clinical significance of pulmonary aspiration during the perioperative period.

BACKGROUND: Pulmonary aspiration of gastric contents during the perioperative period may be associated with postoperative mortality or pulmonary morbidity. Recent determination of the incidence of perioperative pulmonary aspiration and evaluation of factors related to clinical outcomes is lacking. METHODS: We retrospectively reviewed the perioperative courses of 172,334 consecutive patients 18 yr of age or older who underwent 215,488 general anesthetics for procedures performed in all surgical specialties from July 1985 to June 1991. Pulmonary aspiration was defined as either the presence of bilious secretions or particulate matter in the tracheobronchial tree or, in patients who did not have their tracheobronchial airways directly examined after regurgitation, the presence of an infiltrate on postoperative chest roentgenogram that was not identified by preoperative roentgenogram or physical examination. RESULTS: Pulmonary aspiration occurred in 67 patients (1:3,216 anesthetics). Fifteen aspirations occurred in 13,427 (1:895) anesthetics of patients undergoing emergency surgery, and 52 occurred in 202,061 (1:3,886) anesthetics of patients undergoing elective surgery (P < .001). Of the 66 patients who survived their surgery, 42 (64%) did not develop a cough or wheeze, a decrease in arterial hemoglobin oxygen saturation while breathing room air > 10% less than the preoperative value, or radiographic abnormalities within 2 h of aspiration. These 42 patients had no respiratory sequelae. Of the 24 patients who had one or more of these findings, 13 required mechanical ventilatory support for more than 6 h. Three of the six patients whose lungs required mechanical ventilation for more than 24 h died from pulmonary insufficiency (overall mortality = 1:71,829 anesthetics). CONCLUSIONS: This study suggests that patients with clinically apparent aspiration who do not develop symptoms within 2 h are unlikely to have respiratory sequelae.

Adult↗

PubMed1992

Surgical jejunostomy in aspiration risk patients.

One hundred patients underwent laparotomy for independent jejunal feeding tube placement. Neurologic disease was present in 50%, and obtundation (28) and oropharyngeal dysmotility (25) were the most common indications for enteral feeding. The post-pyloric route was chosen because of aspiration risk in almost all (94%) patients. Postoperative (30-day) mortality rate was 21%, because of cardiopulmonary failure in most (18). One death resulted directly from aspiration of tube feeds. Two surgical complications required reoperation: one wound dehiscence and one small bowel obstruction. Four wound infections occurred. Two patients underwent reoperation after tube removal, and four tubes required fluoroscopically guided reinsertion for peritubular drainage (2), removal (1), and occlusion (1). Aspiration pneumonia was present in 18 patients preoperatively and in eight postoperatively. None of the patients with feeding-related preoperative aspiration pneumonia (13) had a recurrence while fed by jejunostomy. Three patients developed postoperative aspiration pneumonia before initiation of jejunostomy feedings. Jejunostomy may be performed with low morbidity rate and substantial reduction of feeding-related aspiration pneumonia, and is the feeding route of choice in aspiration risk patients.

Adult↗

PubMed1993

Using the radionuclide salivagram to detect pulmonary aspiration and esophageal dysmotility.

That the radionuclide "milk" scan is insensitive for aspiration has been demonstrated. Here the authors review their experience with the radionuclide salivagram in its ability to detect aspiration in children. Tc-99m sulfur colloid, 0.5 to 1.0 mCi in less than 1 mL, is instilled into the mouth and sequential supine posterior images of the thorax are obtained for an hour with delayed images until the oropharynx is cleared of radiotracer. Fourteen studies have been performed in 13 patients aged 1 month to 6.5 years. There are scintigraphic findings consistent with aspiration in 4 of 14 studies (28%); dysmotility (prolonged retention of activity in the esophagus) in 7 of 14 studies (50%); and normal studies in 3 of 13 patients (22%). Eight of 13 patients had milk scans; all were negative for aspiration. One patient studied twice had aspiration on the first examination, and dysmotility on the second study. It is concluded that the salivagram can detect aspiration of oral secretions, is superior to the milk scan in detecting aspiration, and can demonstrate esophageal dysmotility.

Child↗

PubMed2004

The role of glottal gap in predicting aspiration in patients with unilateral vocal paralysis.

Aspiration has been frequently noted among patients suffering from vocal-fold paralysis. The association between a defect of glottal closure and aspiration in patients with unilateral vocal paralysis appears to have been rarely reported. The current study reviews collected data consisting of videotaped flexible nasoendoscopy and stroboscopy for patients with a unilateral vocal-fold paralysis. Mean normalized glottal gap areas for patients suffering vocal paralysis with associated aspiration are significant greater than that for the non-aspiration group. Subsequent to the surgical correction of the glottal gap, all patients recovered well from their earlier aspiration. The investigation of objectively derived data revealed that poor airway protection due to incomplete closure of the vocal fold was the major cause of aspiration for patients suffering unilateral vocal-fold paralysis. Intracordal autologous fat injection can successfully improve the breath control and eliminate aspiration in patients with vocal-fold paralysis.

Adult↗

PubMedDate not supplied

Aspiration diseases: findings, pitfalls, and differential diagnosis.

The aspiration of different substances into the airways and lungs may cause a variety of pulmonary complications. These disease entities most commonly involve the posterior segment of the upper lobes and the superior segment of the lower lobes. Esophagography and computed tomography (CT) are especially useful in the evaluation of aspiration disease related to tracheoesophageal or tracheopulmonary fistula. Foreign body aspiration typically occurs in children and manifests as obstructive lobar or segmental overinflation or atelectasis. An extensive, patchy bronchopneumonic pattern may be observed in patients following massive aspiration of gastric acid or water. CT is the modality of choice in establishing the diagnosis of exogenous lipoid pneumonia, which can result from aspiration of hydrocarbons or of mineral oil or a related substance. Aspiration of infectious material manifests as necrotizing consolidation and abscess formation. The relatively low diagnostic accuracy of chest radiography in aspiration diseases can be improved with CT and by being familiar with the clinical settings in which specific complications are likely to occur. Recognition of the varied clinical and radiologic manifestations of these disease entities is imperative for prompt, accurate diagnosis, resulting in decreased morbidity and mortality rates.

Adult↗

PubMed2000

Hemodynamic effects of periodic G(z) acceleration in meconium aspiration in pigs.

The hemodynamic effects of periodic acceleration (pG(z)), induced in the spinal axis with noninvasive motion ventilation (NIMV), were studied in a piglet model of pulmonary hypertension associated with meconium aspiration. Animals (n = 12) were anesthetized, paralyzed, intubated, and supported by conventional mechanical ventilation (CMV). Thirty minutes after tracheal instillation of meconium solution (6 ml/kg), either CMV (n = 6) was continued or NIMV (n = 6) was initiated. Changes in systemic and pulmonary hemodynamics and arterial blood gases were tracked for 2 h after aspiration. Thermodilution, cardiac output, and heart rate were not significantly different after meconium aspiration in the pG(z) group relative to the CMV controls. Aortic pressure and systemic vascular resistance were significantly lower (approximately 30%) after meconium aspiration in NIMV animals relative to CMV animals. Pulmonary arterial pressure and pulmonary vascular resistance were also significantly lower, by 100%, after aspiration of meconium in the NIMV animals compared with the CMV controls. Meconium aspiration significantly decreased total respiratory compliance by approximately 50% and increased total respiratory resistance by approximately 100% in both CMV and NIMV animals, but such alterations did not differ between the two groups. Both CMV and NIMV satisfactorily supported ventilation in these paralyzed animals. In conclusion, NIMV through pG(z) in the spinal axis decreased systemic and pulmonary vascular resistance in piglets after meconium aspiration.

Acceleration↗

PubMed2000

A novel diagnostic method for pulmonary aspiration in a murine model. Immunocytochemical staining of milk proteins in alveolar macrophages.

Aspiration of foreign material into the lungs has been implicated in the etiology of a variety of pulmonary disorders. Although aspiration is a common clinical problem, its diagnosis represents a major challenge due to the lack of sensitive and/or specific tests. In this study, we evaluated the sensitivity and specificity of a novel diagnostic method in a murine model of milk aspiration. Under light anesthesia, BALB/c mice received either single or repeated intranasal instillation of milk. Control animals received sterile physiologic saline or were infected with respiratory pathogens in a similar manner. After isolation and cannulation of the trachea, mouse lungs were lavaged with PBS at various time points after the last aspiration event. Cells were recovered for Oil Red O (ORO) staining as well as immunocytochemistry for milk proteins: alpha-lactalbumin and beta-lactoglobulin. After single aspiration of milk, a large number of alveolar macrophages displayed a strong immunoreactivity for alpha-lactalbumin for 2-96 h. After single and repeated aspiration, the percentage of positive cells for alpha-lactalbumin was significantly higher when compared with ORO staining at 24, 48, and 72 h (p < 0.05). No immunoreactivity for milk proteins was found in alveolar macrophages obtained from our control groups. These findings demonstrate that immunocytochemical staining of milk proteins within alveolar macrophages represents a novel, sensitive, and specific test for the diagnosis of aspiration in a murine model.

Animals↗

PubMed1981

Tracheal mucosal damage after aspiration. A scanning electron Microscope study.

Aspiration of gastric contents causes severe pneumonitis, but the effects of such aspiration on the large airways have not been well studied. To evaluate the effects of gastric contents on the tracheal mucosa, 63 healthy A/J mice were anesthetized and aspirated either sterile saline (pH, 5.9) (Group I), hydrochloric acid (pH, 1.5) (Group II), canine gastric juice (pH, 1.5) (Group III), or canine gastric juice (pH, 5.9) (Group IV). Tracer studies showed that the average amount aspirated was 15% of the administered dose. Animals from each group were killed by cervical dislocation at 1, 6, 24, 48, and 72 h and 7 days after aspiration. Examination of the tracheas by scanning electron microscopy revealed normal mucosa in all Group I animals. Tracheas from Group II animals killed between 6 and 48 h after aspiration showed desquamation of the superficial cell layer with complete loss of ciliated and nonciliated cells. Regeneration was noted at 3 days with complete recovery by 7 days. Tracheas from Group III animals had similar changes but regeneration was delayed, whereas those from Group IV had mild desquamation with delayed regeneration. The lungs of group I animals were normal, and those of animals in Group II through IV showed only small widely separated areas of inflammation. We conclude that (1) gastric contents cause marked damage to the tracheal mucosa even when the amount aspirated is too small to induce a clinically significant pneumonia, (2) damage is more severe when the pH of the gastric content is low, and (3) gastric juice may contain substances that delay healing.

Animals↗

PubMed1997

Pulmonary aspiration in hospitalized adults.

Until recent years, pulmonary aspiration attracted remarkably little clinical investigation. Although aspiration was considered a common occurrence in hospitalized individuals, with serious and even fatal consequences, clinicians had limited scientific data to guide practice. Consequently, approaches to this problem were based largely on unsystematic observations, intuition, and tradition. Recent investigations on the subjects of aspiration have increased our understanding of patients at risk for aspiration, the value of diagnostic methods, and the efficacy of interventions to prevent or limit aspirations. Results of these studies call to question many time-honored adages and practices. Considerable uncertainty remains and more investigation is necessary before management decisions can be characterized clearly and clinical strategies defined. This review focuses on pulmonary aspiration and enteral feeding in the critically ill adult. Factors implicated in aspiration in this population are highlighted and evidence to support the application of interventions prescribed commonly is presented.

Adult↗

PubMed1992

Pulmonary inflammation associated with aspirated meconium and epithelial cells in calves.

"Meconium aspiration syndrome" is a condition resulting in respiratory distress and the occasional death of newborn human beings. A retrospective study was conducted on 52 calves that were submitted for postmortem examination to the Atlantic Veterinary College, Charlottetown, Prince Edward Island, Canada. These calves died of infectious and noninfectious diseases within the first 2 weeks of life due to a variety of causes. The most common cause of death was infectious enteric disease. Histologic examination of lungs revealed that 42.5% of calves had evidence of meconium, squamous cells, or keratin in the lung. There was considerable variation in the magnitude of histologic changes in lungs containing aspirated material. Typically, affected lungs had only a few inconspicuous pieces of meconium, keratin, and squamous cells within bronchoalveolar spaces. Sporadically, the entire lumen of airways was obliterated by aspirated material. Lungs with aspirated material had a mild but diffuse alveolitis characterized by exudation of a few neutrophils, macrophages, and occasional multinucleated giant cells. Obstruction of small airways and focal atelectasis were also observed. Similar lesions have been reported in human meconium aspiration syndrome. It is concluded that histologic changes similar to those of human meconium aspiration syndrome occur commonly in calves that die within 2 weeks of birth. Further studies involving healthy age-matched calves are required to evaluate the clinicopathologic significance of meconium aspiration in this species.

Animals↗

PubMed1998

Anti-aspiration prophylaxis in New Zealand: a national survey.

A postal questionnaire was sent on two occasions to specialist anaesthetists within New Zealand. Questions were related to fasting status, anti-aspiration prophylaxis, incidence of aspiration, definition of high risk groups for aspiration pneumonitis, and identification of departmental guidelines. Two-hundred-and-twenty-three replies were received (72% response rate). Most adults, children and infants were fasted for 6 hours for solids, whilst the majority fasted for 2 to 4 hours for liquids. Two-thirds indicated that they would delay emergency surgery (not life/limb threatening) to optimize gastric emptying. Histamine type 2 receptor antagonists, metoclopramide and cricoid pressure were used commonly, more so in the obstetric population compared to non-obstetric surgery. Preinduction nasogastric intubation and suction were used infrequently. Anti-aspiration prophylaxis was deemed important in morbidly obese patients, those in the third trimester of pregnancy and those with a hiatus hernia, whilst diabetes mellitus, sepsis and renal failure were not considered risk factors for aspiration pneumonitis. 71% of respondents had at least one episode of aspiration (range 0-10), with an overall mortality rate of 5%. Half of these cases of aspiration were deemed to be preventable by the respondent.

Adolescent↗

PubMed1989

Reducing the risk of aspiration pneumonitis.

Regurgitation of gastric contents with subsequent aspiration into the lungs contributes significantly to morbidity and mortality in surgical and nonsurgical patients. The consequences of aspiration pneumonitis depend on the volume and the acidity of the aspirate, and the presence of particulate and bacteria in the aspirate. The occurrence of aspiration pneumonitis may be prevented by correction of risk factors, careful monitoring, and appropriate airway management. The goal of aspiration pneumonitis prophylaxis is to minimize pulmonary complications by controlling risk factors for gastric regurgitation, which include gastric pH less than or equal to 2.5, gastric volume greater than 25 mL, lower esophageal sphincter incompetence, and delayed peristalsis. Prophylactic techniques include nasogastric decompression, acid neutralization, acid suppression, and increased gastric peristalsis. The ability of drugs to alter risk factors does not guarantee that aspiration will not occur, but it does reduce the likelihood of secondary respiratory complications. The ideal prophylactic agent should consistently reduce all risk factors, produce a prompt and sustained response, and possess few adverse effects and drug interactions.

Humans↗

PubMed2000

Recurrent milk aspiration produces changes in airway mechanics, lung eosinophilia, and goblet cell hyperplasia in a murine model.

Recurrent aspiration of milk into the respiratory tract has been implicated in the pathogenesis of a variety of inflammatory lung disorders including asthma. However, the lack of animal models of aspiration-induced lung injury has limited our knowledge of the pathophysiological characteristics of this disorder. This study was designed to evaluate the effects of recurrent milk aspiration on airway mechanics and lung cells in a murine model. Under light anesthesia, BALB/c mice received daily intranasal instillations of whole cow's milk (n = 7) or sterile physiologic saline (n = 9) for 10 d. Respiratory system resistance (Rrs) and dynamic elastance (Edyn,rs) were measured in anesthetized, tracheotomized, paralyzed and mechanically ventilated mice 24 h after the last aspiration of milk. Rrs and Edyn,rs were derived from transrespiratory and plethysmographic pressure signals. In addition, airway responses to increasing concentrations of i.v. methacholine (Mch) were determined. Airway responses were measured in terms of PD(100) (dose of Mch causing 100% increase from baseline Rrs) and Rrs,max (% increase from baseline at the maximal plateau response) and expressed as % control (mean +/- SE). We found recurrent milk aspiration did not affect Edyn and baseline Rrs values. However, airway responses to Mch were increased after milk aspiration when compared with control mice. These changes in airway mechanics were associated with an increased percentage of lymphocytes and eosinophils in the bronchoalveolar lavage, mucus production, and lung inflammation. Our findings suggest that recurrent milk aspiration leads to alterations in airway function, lung eosinophilia, and goblet cell hyperplasia in a murine model.

Administration, Intranasal↗