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PubMed1997

Risks and outcomes of perioperative pulmonary aspiration.

A 95 kg, 34-year-old woman undergoes a laparoscopic tubal ligation. Shortly after endotracheal extubation and during transport to the PACU, she attempts to cough, and gags and vomits. As she is wheeled into the PACU, she is coughing and cyanotic. The anesthesiologist quickly reanesthetizes and reintubates her. Concerned that she may have aspirated the vomitus into her trachea, you suction her endotracheal tube and find thick bilious secretions. How important is pulmonary aspiration? What are the risk factors? When does aspiration occur during the perioperative period? How do you treat pulmonary aspiration? What went wrong here?

Adult↗
PubMed2003

Forensic importance of aspiration.

The problems of assessment of aspiration (foreign bodies, stomach contents, food material) in forensic practical work are well-known, especially if 'suffocation due to aspiration' is considered to be the cause of death (or a concurrent cause of death). In the last 4 years (1998-2001) in the Department of Legal Medicine of the Free University, Berlin, 14 deaths with massive aspirations were investigated. The lethal aspiration cases consisted of seven men and five women between 55 and 91 years old, as well as two children (boy 6 years and girl 19 months old). All but one of the victims had severe neurological alterations (dementia, apoplexia, sequelae of head injuries). In six cases the victims died during or a short time after a meal; they had been fed by the nursing staff, a family member or another caregiver. The witness statements pertaining to clinical symptoms or the course of events ranged from 'no symptoms' to intensive cyanosis, congestion and no clear reactions of distress.

Aged↗
PubMed1994

Sibling and environmental correlates of adolescents' aspirations: family group differences.

Relationships were examined between sibling variables, perceptions of learning environments and aspirations for Australian adolescents from family contexts defined conjointly by human and social capital. Generally, the findings using a regression approach indicated that sibling variables continued to have significant and often complex associations with adolescents' aspirations after taking into account relationships between perceptions of learning environments and aspirations. Also, relationships between sibling variables, perceptions of learning environments and aspirations, varied for adolescents from the different family contexts.

Adolescent↗
PubMed2006

Bilateral medialization thyroplasty: an effective approach to severe, chronic aspiration.

AIMS: To demonstrate the efficacy of bilateral medialization thyroplasty as a treatment for severe, chronic aspiration. To review the literature on surgical options available in the treatment of severe aspiration. MATERIALS AND METHODS: Three cases that underwent bilateral medialization thyroplasty are described. The technique used was the standard medialization thyroplasty described by Isshiki as a unilateral procedure. The assessment and rehabilitation of these patients is discussed. RESULTS: All patients stopped aspirating following surgery. One patient returned to a normal diet and one patient returned to a solid diet. All patients required a permanent tracheostomy. CONCLUSION: Bilateral medialization thyroplasty offers an effective surgical option in the treatment of severe, chronic aspiration. It maintains good voice, with a possible return to oral diet. The operation is easily reversible if the patient's condition alters.

Aged↗
PubMed2000

A method for bronchoscopic evaluation of salivary aspiration in a disabled child.

Chronic aspiration is a cause of life-threatening respiratory complications and repeated hospital admissions, particularly in children with neurological disabilities. Determining the source of aspiration is important for optimizing treatment. This report describes a simple technique to demonstrate salivary aspiration during fibreoptic bronchoscopy. A child with a history of recurrent pneumonia was given methylene blue orally 2 h prior to fibreoptic bronchoscopy. Bronchoscopy was carried out through a laryngeal mask airway under inhalational anaesthesia. The stained saliva was seen to be pooling in the valleculae and then running down the trachea into the bronchi, confirming salivary aspiration.

Bronchoscopy↗
PubMed1999

Combined effects of high-frequency ventilation and surfactant treatment in experimental meconium aspiration syndrome.

BACKGROUND: Deterioration of lung function in meconium aspiration syndrome may in part be due to inactivation of endogenous surfactant. We evaluated the efficacy of high-frequency ventilation (HFV) and the combination of HFV and surfactant therapy in the management of respiratory failure induced by experimental meconium aspiration in adult rats. METHODS: Animals were anesthetized and tracheotomized, and received via the tracheal cannula a suspension of human meconium (25 mg/ml, dose 4 or 5 ml/kg). After 30 min of conventional ventilation (CV) with 100% oxygen, animals were in respiratory failure as indicated by a decrease in lung-thorax compliance of > or = 30% and PaO2 < 10 kPa. They were then ventilated for an additional 3 h with either CV (frequency 40/min, inspiration time 50%) or HFV (frequency 15 Hz, inspiration time 50%) using comparable mean airway pressures (about 20 cmH2O) and variable FiO2. Subgroups of animals were treated with Curosurf (80 mg/ml, dose 200 mg/kg) 30 min after meconium aspiration; no additional material was instilled in controls. RESULTS: From 30 min onwards, values for PaO2/FiO2 were significantly higher in animals ventilated with HFV without receiving surfactant than in control animals subjected to CV alone (at 120 min; 18 +/- 7.3 vs. 7.4 +/- 0.8 kPa, P < 0.05). Additional improvement in oxygenation was seen in HFV-treated animals receiving Curosurf (at 120 min: 39 +/- 16 kPa: P vs. HFV alone < 0.01). Relative lung volumes at a deflation pressure of 10 cmH2O, expressed as percent of maximum volume, were larger in animals ventilated with HFV than in those undergoing CV (41 +/- 12 vs. 33 +/- 10%; P < 0.05), and were further increased in the groups of animals treated with surfactant and ventilated with HFV (55 +/- 9.9%; P vs. animals ventilated with HFV not receiving surfactant < 0.01) or CV (49 +/- 9.6%; P vs. animals ventilated with CV without receiving surfactant < 0.05). Hyaline membranes, granulocytes in cytospin preparations from lung lavage fluid, and vascular-to-alveolar leak of albumin were less prominent in the HFV than in the CV group, particularly in animals treated with surfactant. CONCLUSION: Our data indicate that HFV, especially in combination with surfactant therapy, may be superior to CV for treatment of respiratory failure in this animal model of meconium aspiration syndrome.

Air Pressure↗
PubMed2000

Acute lung injury by sepsis and acid aspiration: a key role for cytosolic phospholipase A2.

Adult respiratory distress syndrome (ARDS) is characterized by acute lung injury with a high mortality rate and yet its mechanism is poorly understood. Sepsis syndrome and acid aspiration are the most frequent causes of ARDS, leading to increased lung permeability, enhanced polymorphonuclear neutrophil (PMN) sequestration and respiratory failure. Using a murine model of acute lung injury induced by septic syndrome or acid aspiration, we investigated the role of cytosolic phospholipase A2 (cPLA2) in ARDS. We found that disruption of the gene encoding cPLA2 significantly reduced pulmonary edema, PMN sequestration and deterioration of gas exchange caused by lipopolysaccharide and zymosan administration. Acute lung injury induced by acid aspiration was similarly reduced in mice with a disrupted cpla2 gene. Our observations suggest that cPLA2 is a mediator of acute lung injury induced by sepsis syndrome or acid aspiration. Thus, the inhibition of cPLA2-initiated pathways may provide a therapeutic approach to acute lung injury, for which no pharmaceutical agents are currently effective.

Animals↗
PubMed2000

Effects of magnesium sulfate in a newborn piglet meconium aspiration model.

OBJECTIVE: To examine the hemodynamic effects of magnesium sulfate (MgSO4) in a neonatal model of meconium aspiration syndrome. DESIGN: A prospective animal study. PATIENTS AND PARTICIPANTS: Eight anesthetized neonatal piglets. METHODS: Animals were instrumented under fentanyl anesthesia for the determination of pulmonary and systemic blood pressures and cardiac index. A model of meconium aspiration was produced by instilling 6 to 7 ml of 20% fresh human meconium in normal saline down the endotracheal tube, resulting in hypoxemia (mean arterial O2 saturation 73 SD, 10%), respiratory acidosis (mean pH 7.08, SD 0.04; PaCO2 89, SD 2 torr), and pulmonary arterial hypertension (mean pulmonary artery pressure 52 SD, 5 mm Hg). A total of four aliquots of MgSO4 (25 mg/kg equivalent to 0.1 mM/kg of magnesium) were administered intravenously to five animals (total of 100 mg/kg MgSO4). Three animals served as controls and did not receive MgSO4. RESULTS: Each dose of MgSO4 was associated with a transient decrease in heart rate, cardiac index, pulmonary and systemic arterial pressures, and SaO2, followed by a partial gradual recovery of all these variables within 2 to 3 minutes. According to measurements taken after MgSO4 therapy, there was a significant decrease in arterial saturations (from 73 SD (10%) to 63 SD (13%); p < 0.05), mean systemic blood pressure (from 77 SD (16 mm Hg) to 74 SD (15 mm Hg); p < 0.05) and pulmonary artery pressure (to 52 SD (5 mm Hg); p < 0.05). The ratio between pulmonary and systemic vascular resistance was not significantly affected by MgSO4 therapy. There were no changes in the control animals. CONCLUSION: The administration of magnesium sulfate is associated with increased hypoxemia in this model of meconium aspiration syndrome, probably because of worsening ventilation perfusion mismatch. These data do not provide any physiological support for the use of MgSO4 in the neonate with meconium aspiration and pulmonary hypertension and suggest that this agent should be used cautiously, if at all, in such situations.

Animals↗
PubMed2000

Peripartum general anasthesia without tracheal intubation: incidence of aspiration pneumonia.

This study estimated the incidence of pulmonary aspiration during general anasthesia for obstetric procedures performed in the peripartum period (Caesarean sections were not studied). The records of 1870 patients anasthetised without tracheal intubation were reviewed retrospectively. The diagnosis of aspiration was based on the anasthetist's written remarks and the postoperative course. Eighty per cent of patients received ketamine and a benzodiazepine, and the remaining 20% received methohexital or thiopental and fentanyl. No cricoid pressure or tracheal intubation was performed. A single case of mild aspiration was detected in a woman anasthetised with methohexital (an incidence of 0.053%). These results suggest that the risk of aspiration during general anasthesia without tracheal intubation, during and immediately after delivery, may not be higher in obstetric patients in the peripartum period, as has been reported previously.

Adult↗
PubMed2003

Treatment of recurrent aspiration pneumonia in end-stage dementia: preferences and choices of a group of elderly nursing home residents.

BACKGROUND: Clinicians are often faced with the dilemma of how best to manage patients with advanced dementia who present to the hospital with repeated episodes of aspiration pneumonia. Rarely, if at all, are the opinions of the group that is most likely to be directly affected, that is the older nursing home resident, sought. This study seeks to fill that gap. AIMS: To study the choices and preferences of a group of elderly nursing home residents in the treatment of recurrent aspiration pneumonia on a background of severe disability from end-stage dementia. METHODS: A descriptive cross-sectional interview study using a hypothetical scenario carried out in six nursing homes within eastern Sydney, from June to August 2000. Views and attitudes towards hospitalization, antibiotic use, tube feeding and other treatment measures, given a situation of recurrent aspiration pneumonia and end-stage dementia, were obtained. RESULTS: Fifty-two elderly nursing home residents who were cognitively intact and not depressed were interviewed. Most of the subjects would prefer further hospital admissions (61.5%, P<0.1) and would choose to have antibiotic treatment (73.1%, P<0.001). Slightly more than half would not agree to artificial ventilation. Sixty-nine percent of the respondents would not agree to feeding via a nasogastric tube (P<0.05) and 71% would not agree to a feeding gastrostomy (P<0.001). Most would agree to a modified diet (75%, P<0.0001) and to continue oral feeding despite the attendant risk of re-aspiration (59.6%, P<0.01). CONCLUSIONS: The participants generally preferred to be treated in a hospital setting given the scenario. Most disagreed with the use of artificial feeding.

Aged↗
PubMed1989

[Cinematographic study of the pathologic mechanisms of aspiration pneumonia].

6% of all patients suffering from a cerebrovascular injury die from aspiration pneumonia within the first year. The high temporal resolution of high-speed cineradiography (HFK) (50 frames/sec.) allows the recording of the 0.7 sec. process of pharyngeal swallow. Five case-examples are presented (total number of cases: 95) illustrating the possibility of differentiation between three types of aspiration by means of cineradiography. These types are the so-called pre-, intra- and postdeglutitive aspiration, that is aspiration before or after triggering of the swallowing reflex. This differentiation is of great therapeutic importance. The analysis of disturbances of pharyngo-laryngeal motility and the temporal coordination allows setting up individual surgical and/or conservative programme for rehabilitation.

Adult↗
PubMed2005

Amnioinfusion for the prevention of the meconium aspiration syndrome.

BACKGROUND: It is uncertain whether amnioinfusion (infusion of saline into the amniotic cavity) in women who have thick meconium staining of the amniotic fluid reduces the risk of perinatal death, moderate or severe meconium aspiration syndrome, or both. METHODS: We performed a multicenter trial in which 1998 pregnant women in labor at 36 or more weeks of gestation who had thick meconium staining of the amniotic fluid were stratified according to the presence or absence of variable decelerations in fetal heart rate and then randomly assigned to amnioinfusion or to standard care. The composite primary outcome measure was perinatal death, moderate or severe meconium aspiration syndrome, or both. RESULTS: Perinatal death, moderate or severe meconium aspiration syndrome, or both occurred in 44 infants (4.5 percent) of women in the amnioinfusion group and 35 infants (3.5 percent) of women in the control group (relative risk, 1.26; 95 percent confidence interval, 0.82 to 1.95). Five perinatal deaths occurred in the amnioinfusion group and five in the control group. The rate of cesarean delivery was 31.8 percent in the amnioinfusion group and 29.0 percent in the control group (relative risk, 1.10; 95 percent confidence interval, 0.96 to 1.25). CONCLUSIONS: For women in labor who have thick meconium staining of the amniotic fluid, amnioinfusion did not reduce the risk of moderate or severe meconium aspiration syndrome, perinatal death, or other major maternal or neonatal disorders.

Amniotic Fluid↗
PubMed2006

Closure of laryngotracheal cavity and tracheostomy for intractable aspiration secondary to radiation encephalopathy or radiation damage of cranial nerve after radiotherapy of nasopharyngeal carcinoma.

CONCLUSIONS: Closure of the laryngotracheal cavity and tracheostomy is especially suitable for intractable aspiration secondary to radiation encephalopathy or damage of cranial nerve after radiation for nasopharyngeal carcinoma (NPC). OBJECTIVE: To investigate the clinical value, technique, indications and contraindications of closure of the laryngotracheal cavity and tracheostomy for intractable aspiration secondary to radiation encephalopathy (REP) or radiation damage of cranial nerve after radiotherapy of NPC. PATIENTS AND METHODS: Thirty patients, suffering from intractable aspiration secondary to radiotherapy for nasopharyngeal carcinoma, were treated with closure of the laryngotracheal cavity and tracheostomy and were observed for at least 1 year. RESULTS: Intractable aspiration and dyspnea were completely eradicated in all patients. The quality of their life was greatly improved.

Adult↗
PubMed1996

Ethnicity, family achievement syndrome, and adolescents' aspirations: Rosen's framework revisited.

Relationships between the achievement syndrome of families from different Australian ethnic groups, family social status, and adolescents' educational and occupational aspirations were examined. The investigation was generated from a particularly significant set of studies of family environments conducted by Rosen (e.g., 1956, 1959, 1961, 1962, 1973). Longitudinal data were collected from 16-year-olds (N = 465) and their parents from Anglo-Australian, Greek, and southern Italian groups in Australia. The findings suggest that (a) there are substantial ethnic group differences in the dimensions of the family achievement syndrome and more modest group variations in aspirations for adolescents from different Australian ethnic groups, (b) family social status and the dimensions of the family achievement syndrome have a restricted set of modest to moderate associations with adolescents' aspirations, and (c) ethnic group variations in adolescents' aspirations are mediated largely by differences in measures of the family achievement syndrome and family social status.

Achievement↗
PubMed1998

Family capital, children's individual attributes, and adolescents' aspirations: a follow-up analysis.

In this follow-up study of an earlier investigation (Marjoribanks, 1992), relationships were examined between family capital, children's individual attributes, immediate family settings, and adolescents' aspirations. There were 500 Australian adolescents (250 girls, 250 boys) and their parents in the sample. The results of this study and of the earlier investigation suggest that (a) family environmental contexts are moderately to largely associated with children's academic performances and adolescents' aspirations; (b) relationships between family contexts, children's individual attributes, and adolescents' aspirations are mediated fully or in part by adolescents' perceptions of their parents' support for learning; and (c) there are gender-related differences in the nature of the associations among family capital, individual attributes, immediate family settings, and adolescents' aspirations.

Achievement↗
PubMed1990

Critical volume for pulmonary acid aspiration: reappraisal in a primate model.

We have studied, in the monkey, the critical volume for the production of severe pneumonitis following pulmonary aspiration of gastric contents. Aspiration of 0.4 ml kg-1 and 0.6 ml kg-1 at pH1 produced mild to moderate clinical and radiological changes, but no deaths. Aspiration of 0.8 ml kg-1 and 1.0 ml kg-1 at pH1 was associated with an increasingly severe pneumonitis. At 1.0 ml kg-1, 50% of the animals died--a mortality rate considerably less than that reported previously in animal studies. If these results were to be extrapolated to humans, the critical volume for severe aspiration could be increased from 25 ml to 50 ml (0.8 ml kg-1), considerably reducing the percentage of patients perceived to be "at risk".

Animals↗
PubMed1999

The role of tumor necrosis factor-alpha in the pathogenesis of aspiration pneumonitis in rats.

BACKGROUND: Aspiration pneumonitis is characterized by proteinaceous pulmonary edema and acute infiltration of neutrophils into the alveolar space. This study examined the role of the proinflammatory cytokine, tumor necrosis factor-alpha (TNF-alpha), on the pathogenesis of the injury produced by the different components that may be present in the aspirate, acid, or gastric particles. METHODS: Rats were injured by intratracheal instillation of a vehicle containing acid or gastric particles. TNF-alpha concentration of bronchoalveolar lavage fluid was determined using a bioassay. upregulation of lung TNF-alpha mRNA was also measured. The effect of intratracheal anti-rat TNF-alpha treatment was assessed by lung protein permeability, blood gases, and lung myeloperoxidase activity. RESULTS: Injury vehicle alone and acid injury resulted in a small TNF-alpha peak 1-2 h after injury in the lavage fluid. Both particulate and acidic particulate groups produced a much more robust TNF-alpha signal that reached a plateau at 2-4 h after injury and declined at 8 h. Upregulation of TNF-alpha mRNA was only detected in the particulate-containing groups. Acidic particulate exposure yielded a synergistic increase in protein permeability and decrease in blood oxygenation. Anti-TNF-alpha treatment reduced protein permeability and myeloperoxidase activity and increased blood oxygenation in the groups exposed to only acid. Such treatment had no effect on either of the particulate containing injuries. CONCLUSIONS: TNF-alpha is differentially manifested according to the components that make up the aspirate but the levels of TNF-alpha expression do not correlate with the severity of the resultant injury. However, the reduction in acid-induced lung injury by anti-TNF-alpha treatment indicates that TNF-alpha plays a role in the pathogenesis of aspiration pneumonitis.

Animals↗
PubMed1995

Acute, subacute, and chronic histologic effects of simulated aspiration of a 0.7% sucralfate suspension in rats.

OBJECTIVE: To assess the acute (4-hr), subacute (7-day), and chronic (21-day) effects of simulated aspiration of a 0.7% sucralfate suspension in rats. DESIGN: Prospective, multigroup trial in which rats were randomized to various simulated aspiration groups. SETTING: Experimental animal laboratory. SUBJECTS: Forty-five Sprague-Dawley rats. INTERVENTIONS: Simulated aspiration was induced by single, direct, tracheal instillation of 2 mL/kg of either room air, sucralfate, or normal saline. MEASUREMENTS AND MAIN RESULTS: Lung histologic changes were assessed using a quantitative numerical scoring scale. There was an increase in bronchiolar inflammation in rats undergoing acute, simulated sucralfate aspiration compared with controls. There were no significant differences (p > .05) in any other features at any time interval studied (two-way analysis of variance). CONCLUSIONS: Even though significant inflammatory airway lesions were produced in this acute model, these abnormalities resolved without evidence of subacute or chronic histologic progression. It remains to be determined if this pattern is unique to this specific experimental model or if it can be extrapolated to critically ill patients.

Animals↗