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PubMed1995

Contribution of airway hyperresponsiveness to lower airway obstruction after extracorporeal membrane oxygenation for meconium aspiration syndrome.

OBJECTIVE: To determine whether airway hyperresponsiveness contributes to the development of lower airway obstruction in infants recovering from severe meconium aspiration syndrome treated with extracorporeal membrane oxygenation (ECMO). DESIGN: Prospective comparison study of the response to bronchodilator during the acute and convalescent phase of severe meconium aspiration. SETTING: Pediatric/neonatal intensive care unit in a tertiary care hospital. PATIENTS: Seven neonates with severe meconium aspiration syndrome that was refractory to conventional mechanical ventilation, requiring ECMO treatment. INTERVENTIONS: Evaluation of the effect of bronchodilator treatment on the airway function at a postnatal age of 14 +/- 2.7 (SEM) days, after the patients had been off ECMO for 4.6 +/- 1.4 days, and comparison with the response the same patients had shown at a postnatal age of 2.7 +/- 0.6 days, when they had been on ECMO for 1.3 +/- 0.6 days. Lung mechanics and lower airway function were measured and compared before and after administration of aerosolized isoetharine early in the course of ECMO and again several days after ECMO. Maximum expiratory flow-volume curves produced by the deflation flow-volume curve technique were used for evaluating the lower airway function, and partial passive flow-volume curves were used for measuring respiratory system compliance and resistance. MEASUREMENTS AND MAIN RESULTS: During the first test, isoetharine produced a mild increase in maximum expiratory flows at 25% (MEF25) of forced vital capacity (FVC) (48 +/- 27% compared with baseline values), without significant change in the MEF25 to FVC ratio. During the second test approximately 2 wks later (post-ECMO), isoetharine increased MEF25 by 123 +/- 29% and increased the MEF25/FVC by 40 +/- 13% compared with baseline values. The percent change in both indices was significantly higher during the second test (p < .05) than in the first test. CONCLUSIONS: Airway obstruction in infants recovering from severe meconium aspiration syndrome is partially reversible with aerosolized isoetharine, indicating that airway hyperresponsiveness contributes to the pathogenesis of airway obstruction.

Airway Obstruction↗
PubMed1998

High-frequency oscillatory ventilation versus conventional ventilation in a piglet model of early meconium aspiration.

OBJECTIVE: To compare the cardiopulmonary effects of high-frequency oscillatory ventilation (HFO) and conventional ventilation (CV) in a piglet model of meconium aspiration syndrome. DESIGN: Prospective, randomized control study. SUBJECTS: Piglets 1 to 2 wks of age. INTERVENTIONS: Meconium aspiration was induced in 30 piglets. They were then randomized to CV, HFO at 10 Hz, or HFO at 15 Hz. MEASUREMENTS AND MAIN RESULTS: Arterial blood gas, and systemic and pulmonary hemodynamics were measured serially. Airway opening pressure (P-Flex), static lung compliance (Crs), and trapped gas volume (TGV) were derived. Meconium instillation produced similar stable decreases in Crs (6.7 +/- 0.7 [SEM] to 4.7 +/- 0.4 mL/cm) and increases in pulmonary vascular resistance (68 +/- 6.4 vs. 91.9 +/- 8.5 mm Hg/mL/kg/min). A greater proportion of animals (40%, p< .007) remained hypercarbic during HFO at 15 Hz. Oxygenation indices were similar for all groups. In regards to high-frequency support, both power and deltaP were higher in the HFO at 15 Hz group (p< .001). When compared with both CV and HFO at 10 Hz, the TGV in the HFO at 15 Hz group was significantly higher following randomization to ventilator type. P-Flex was also greatest in the 15 Hz group, followed by the 10 Hz group and the CV group. Higher airway opening pressures, given identical compliance, suggest that HFO at 15 Hz resulted in greater large airway obstruction. With HFO's inherent low tidal volumes, progression of meconium to the distal airways may be delayed. CONCLUSIONS: Early institution of HFO at 15 Hz in meconium aspiration may exacerbate air trapping. HFO at lower rates may be the optimal method of respiratory support in meconium aspiration syndrome. HFO may extend the window of time available for removal of meconium.

Animals↗
PubMed1997

Laryngopharyngeal sensory testing with modified barium swallow as predictors of aspiration pneumonia after stroke.

Improved diagnostic tests that can accurately identify subjects at high risk for aspiration pneumonia (AP) are needed. One measure of this accuracy is the false-negative rate (FNR), which determines the failure of a test to identify a group at high risk. This study compares FNRs for AP among dysphagic stroke patients for two prognostic techniques: modified barium swallow (MBS) alone and MBS combined with laryngopharyngeal sensory discrimination testing (MBS + LPSDT). MBS and LPSDT were performed within 4 weeks of stroke in 20 subjects who were prospectively followed for at least 2 years to identify the frequency of AP. MBS identified 10 patients as not at risk based on the finding of no aspiration on initial MBS; four of these patients developed AP (FNR = 40%). MBS + LPSDT identified five patients as not at risk based on the findings of neither aspiration nor bilateral sensory deficits; none of these patients developed AP (FNR = 0%). The combination of MBS criterion (aspiration) with the LPSDT criterion (bilateral sensory deficits) improves prognostication of outcome in dysphagic stroke patients by identifying a subgroup at high risk for developing AP (nonaspirators with bilateral deficits).

Adult↗
PubMed2000

Aspiration of nasal secretions into the lungs in patients with acute sinonasal infections.

OBJECTIVES: To compare the amounts of nasal secretions aspirated into the lower airway by patients with acute sinonasal infection with that aspirated by healthy adults during sleep. STUDY DESIGN: Sixteen patients who had received a diagnosis of acute sinonasal infections by accurate history, anterior rhinoscopic examination, and radiological assessment and 13 healthy volunteers, aged 14 to 45 years. METHODS: A 10-mCi dose of technetium 99m-labeled macroaggregated albumin (Tc-99m MAA) with a concentration of 1 mCi/mL was prepared at midnight, just before sleep. Each subject was administered two puffs of this spray. At 8 AM the next morning transmission and emission views of the thorax were taken with a gamma camera. RESULTS: No significant difference between the two groups was observed in the amounts of nasal secretions aspirated into the lungs. CONCLUSIONS: The amount of nasal secretions aspirated does not increase during acute sinonasal infection. However, by irritating the mucosa of the lower respiratory tracts, bacteria, toxins, and inflammatory products existing in purulent secretions may play a major role in the pathophysiology of asthma and sinusitis.

Acute Disease↗
PubMed2003

The accuracy of the modified Evan's blue dye test in predicting aspiration.

OBJECTIVES/HYPOTHESIS: The modified Evan's blue dye test (MEBDT) is a relatively simple, inexpensive bedside procedure for the assessment of aspiration in the tracheotomized patient. Recent investigations have questioned its diagnostic accuracy. The purpose of the study was to evaluate the accuracy of the MEBDT in predicting aspiration among tracheotomized patients. STUDY DESIGN: Prospective observational study. METHODS: In the setting of a long-term acute care hospital, all persons with a tracheotomy tube undergoing a bedside swallowing evaluation between October 1, 2001, and March 31, 2002, were prospectively evaluated. All individuals underwent a MEBDT and a subsequent fiberoptic endoscopic evaluation of swallowing (FEES) using a standardized protocol. The sensitivity and specificity of the MEBDT in predicting aspiration were determined. RESULTS: Thirty persons were evaluated. The mean age of the cohort was 65 years (SD +/- 11 y). Sixty percent (18 of 30) were men. The sensitivity and specificity of the MEBDT for the entire cohort were 82% and 38%, respectively. The sensitivity of the MEBDT for patients receiving mechanical ventilation was 100% compared with 76% for individuals not receiving mechanical ventilation. The specificity of the MEBDT remained low, regardless of ventilator status (33%-40%). CONCLUSION: The sensitivity of the MEBDT in predicting aspiration among individuals in our cohort was 82%. The sensitivity was even higher (100%) when performed on persons receiving mechanical ventilation. These results support the use of the MEBDT as a screening tool for persons with a tracheotomy tube. The specific technique of performing the MEBDT is imperative, and the results of the study must be differentiated from other reports evaluating the MEBDT that use a different test protocol.

Adolescent↗
PubMed1986

Radionuclide study of bronchial aspiration in intensive care newborn children.

Newborn children, fitted with tracheal prosthesis for mechanical ventilation, may present chronic pulmonary complications due to the repetition of silent aspirations following gastroesophageal reflux. We evaluated, in a newborn intensive care population, the frequency of such aspirations and the relationship between the different parameters and pathologies. This particular group of sick neonates cannot be moved, and as the hospital for the newborn is far from the Nuclear Medicine district, the patients cannot be scanned. We used a simple technique: the injection of a solution of 99Tcm-sulphur colloid in their gastric tube, and the measurement of the tracheal aspiration tubes' radioactivity. Thirty one children were tested; thirteen children (42%) had radioactive tracheal tubes. The study of the relationship between several parameters and our results, shows that the examination was generally positive when the maximal insufflation pressure value was low. Our results prove that silent aspirations are very frequent in such a population and that it will be perhaps useful to prevent them in a systematic way in order to save the neonates from developing pulmonary lesions.

Female↗
PubMed1992

Gastrografin-induced aspiration pneumonia: a lethal complication of computed tomography.

A 43-year-old man with dysphagia and a tendency to aspirate was found to have squamous cell carcinoma of the esophagus. Curative surgery was planned and preoperative computed tomography of the chest and abdomen was ordered. A ward nurse administered Gastrografin according to a "standing" order, 4 hours before the CT was to be done. The patient aspirated about 50 mL of Gastrografin, and went into cardiorespiratory arrest caused by pulmonary edema. He sustained severe brain damage and died. This is a first report of lethal aspiration of Gastrografin, given in preparation for CT. We advise alerting nurses who administer Gastrografin, especially to patients with dysphagia or impaired consciousness about the grave consequences that can result if the contrast agent is aspirated by the patient. We further advise that responsibility for using contrast agents in radiologic procedures be assumed by the radiologist and not by medical house staff.

Adult↗
PubMed2006

The effect of intermittent nasogastric feeding on preventing aspiration pneumonia in ventilated critically ill patients.

This randomized, controlled study employed two feeding protocols for 107 participants in two intensive care units (ICUs) of a medical center to investigate the efficacy of intermittent nasogastric (NG) feeding in preventing aspiration pneumonia in critically ill patients on ventilators. The participants were randomly assigned to receive continuous (51 patients) or intermittent (56 patients) feeding. The primary outcomes, including gastric emptiness index and pulmonary aspiration index, were examined on Day 0 and Day 7 of the intervention. In addition, patients were followed up to the 21st day to evaluate the secondary outcomes, which included length of stay (LOS) in the ICU and airway status. The results showed that the patients in the intermittent feeding group had a higher total intake volume at Day 7 (p = .000), had been extubated earlier at Day 21 (p = .002), and had a lower risk of aspiration pneumonia (odds ratios: 0.146, 95% CI = 0.062-0.413, p = .000) than the patients in the control group. Participants being treated with a high dose of dopamine were 2.95 times more likely to get aspiration pneumonia than those receiving a low dose of dopamine (95 % CI = 1.076-8.107, p = .035). However, there was no significant difference between the two groups'; LOS. The results of this study provide evidence that clinical caregivers may use to make better decisions in terms of feeding methods for critically ill patients.

Critical Illness↗
PubMed2004

Prediction of laryngeal aspiration using voice analysis.

OBJECTIVE: To determine the diagnostic value of voice analysis to screen for patients with high risk of clinically significant aspiration. DESIGN: A total of 93 patients referred for a videofluoroscopic swallowing study were included in the study. Voice analyses were performed before and after videofluoroscopic swallowing study, and five acoustic variables were measured, including average fundamental frequency, relative average perturbation, shimmer percentage, noise-to-harmonic ratio, and voice turbulence index. The patients were divided into two groups based on the results of the videofluoroscopic swallowing study: a high-risk group with patients who had the ingested materials on or below the vocal cords and a low-risk group with patients who did not have the ingested materials on or below the vocal cords. The changes of each acoustic variable before and after the videofluoroscopic swallowing study were compared between the two groups. RESULTS: Relative average perturbation, shimmer percentage, noise-to-harmonic ratio, and voice turbulence index were significantly increased after videofluoroscopic swallowing study in the high-risk group as compared with the low-risk group (P < 0.05). The change of average fundamental frequency, however, was not significantly different between the two groups (P > 0.05). According to the receiver operating characteristics curve, the sensitivity of these acoustic variables in detecting aspiration or penetration ranged from 68.9% to 91.1% and specificity ranged from 68.8% to 97.9%. Relative average perturbation was the most accurate variable, with a sensitivity of 91.1% and a specificity of 97.9% in predicting aspiration or penetration. The combination of relative average perturbation and noise-to-harmonic ratio increased the sensitivity to 100% but reduced the specificity to 77.1%. CONCLUSION: Voice analysis is a safe, noninvasive, and reliable screening tool for patients with dysphagia and can detect patients at high risk of clinically significant aspiration, thereby augmenting clinical bedside examination.

Aged↗
PubMed2005

DNA identification of the pathogen of candidal aspiration pneumonia induced in the course of oral cancer therapy.

Aspiration of oropharyngeal bacteria and fungi is occasionally suspected in patients with pneumonia. A patient with oral carcinoma underwent chemoradioimmunotherapy and, about 4 weeks from the start of the therapy, the patient suffered from severe oral mucositis induced by chemoradiotherapy, and candidal pneumonia was subsequently induced. The candidal pneumonia was insufficiently improved by potent antifungal drugs, taking a lethal course. Randomly amplified polymorphic DNA analysis and DNA sequence examination of strains isolated from the oral cavity 1 week before the onset of pneumonia and autopsied lung revealed the identity of both strains as Candida albicans, and the DNA analysis supported aspiration of oral Candida. These results indicate that the pathogen of the pneumonia, C. albicans, was aspirated from the oral cavity and that oral Candida is easily aspirated and becomes the pathogen of pneumonia.

Aerosols↗
PubMed1996

The efficacy and optimum time of administration of ranitidine in the prevention of the acid aspiration syndrome.

In order to evaluate the efficacy of a single oral dose of ranitidine 150 mg and the optimum time for its administration, we studied pH and volume measurements in 138 surgical patients, who formed six groups according to the time elapsed from ranitidine administration to gastric fluid aspiration as follows: group A: no ranitidine, group B: 60-90 min, group C: 91-120 min, group D: 121-150 min, group E: 151-180 min and group F: > 180 min. The patients from groups B, C, D, E and F had a significant increase in gastric pH and a significant decrease in gastric fluid volume when compared to the patients from group A. 33.3% (95% CI 16.63-53.22%) of patients in group A were deemed 'at risk' of acid aspiration compared to 0.9% (95% CI 0.02-4.90%) in the other groups. No significant differences were found between the patients receiving ranitidine after 60 min with respect to risk of acid aspiration. It is concluded that a single oral dose of ranitidine 150 mg is effective against the acid aspiration syndrome 60 min after administration.

Adult↗
PubMedDate not supplied

Parent academic involvement as related to school behavior, achievement, and aspirations: demographic variations across adolescence.

A longitudinal model of parent academic involvement, behavioral problems, achievement, and aspirations was examined for 463 adolescents, followed from 7th (approximately 12 years old) through 11th (approximately 16 years old) grades. Parent academic involvement in 7th grade was negatively related to 8th-grade behavioral problems and positively related to 11th-grade aspirations. There were variations across parental education levels and ethnicity: Among the higher parental education group, parent academic involvement was related to fewer behavioral problems, which were related to achievement and then aspirations. For the lower parental education group, parent academic involvement was related to aspirations but not to behavior or achievement. Parent academic involvement was positively related to achievement for African Americans but not for European Americans. Parent academic involvement may be interpreted differently and serve different purposes across sociodemographic backgrounds.

Achievement↗
PubMed1988

Early pregnancy termination: a comparison between vacuum aspiration and medical abortion using prostaglandin (16,16 dimethyl-trans-delta 2-PGE1 methyl ester) or the antiprogestogen RU 486.

Three different regimens for termination of early pregnancy by medical means were compared to vacuum aspiration. Women seeking therapeutic abortion of pregnancy (less than or equal to 56 days amenorrhoea) were allocated to one of four treatment groups: (1) vacuum aspiration (n = 28); (2) 1 mg vaginal pessary of a prostaglandin analogue (gemeprost) every 3 h for up to 5 pessaries (n = 30); (3) the antigestogen (RU 486--mefipristone) 150 mg per day for 4 days by mouth (n = 20); (4) RU 486 in the same dose as group 3 together with 1 mg gemeprost on day 3 (n = 19). Complete abortion occurred more often in women treated with vacuum aspiration (96%), gemeprost alone (97%) and RU 486 plus gemeprost (95%) than in those treated with RU 486 alone (60%). In women receiving up to five gemeprost pessaries alone vomiting occurred in 7 (23%) and diarrhoea in 10 (33%); 16 (53%) required parenteral opiates for relief of pain. Side-effects and analgesic requirements were much reduced in the women who received RU 486 alone or in combination with a single gemeprost pessary. There was no difference in the number of days of vaginal bleeding after abortion between the four groups although there was wide individual variation (mean 10 days, range 1-34). These results confirm that medical induction of abortion in early pregnancy with prostaglandin vaginal pessaries is as effective as vacuum aspiration and that the dose can be reduced five-fold without loss of efficacy when used in combination with RU 486.

Abortion, Therapeutic↗
PubMed1987

Meconium aspiration--role of obstetric factors and suction.

Meconium aspiration occurred in 66 of 120 infants with meconium-stained liquor admitted to a Neonatal Unit. Four of the 66 infants died, whilst 17 other required ventilatory support. Meconium aspiration syndrome, especially when severe, was more likely if the mother was a smoker, hypertensive, anaemic, Maori or the pregnancy was greater than 42 weeks' gestation. Meconium aspiration was also associated with thick meconium, prolonged labour, late fetal heart decelerations and inadequate suctioning of the airway at birth. Although meconium-stained liquor is a common occurrence in labour, a bad neonatal outcome will only be obviated by vigilant intrapartum care and active suctioning of the infant's airway at birth. Once aspiration has occurred, intensive treatment is often required and sometimes fails.

Ethnicity↗
PubMed2006

The effect of reflux and bile acid aspiration on the lung allograft and its surfactant and innate immunity molecules SP-A and SP-D.

Gastro-esophageal reflux and related pulmonary bile acid aspiration were prospectively investigated as possible contributors to postlung transplant bronchiolitis obliterans syndrome (BOS). We also studied the impact of aspiration on pulmonary surfactant collectin proteins SP-A and SP-D and on surfactant phospholipids--all important components of innate immunity in the lung. Proximal and distal esophageal 24-h pH testing and broncho-alveolar lavage fluid (BALF) bile acid assays were performed prospectively at 3-month posttransplant in 50 patients. BALF was also assayed for SP-A, SP-D and phospholipids expressed as ratio to total lipids: phosphatidylcholine; dipalmitoylphosphatidylcholine; phosphatidylglycerol (PG); phosphatidylinositol; sphingomyelin (SM) and lysophosphatidylcholine. Actuarial freedom from BOS was assessed. Freedom from BOS was reduced in patients with abnormal (proximal and/or distal) esophageal pH findings or BALF bile acids (Log-rank Mantel-Cox p < 0.05). Abnormal pH findings were observed in 72% (8 of 11) of patients with bile acids detected within the BALF. BALF with high levels of bile acids also had significantly lower SP-A, SP-D, dipalmitoylphosphatidylcholine; PG and higher SM levels (Mann-Whitney, p < 0.05). Duodeno-gastro-esophageal reflux and consequent aspiration is a risk factor for the development of BOS postlung transplant. Bile acid aspiration is associated with impaired lung allograft innate immunity manifest by reduced surfactant collectins and altered phospholipids.

Bile Acids and Salts↗
PubMed1986

The value of serum IgE assay in milk aspiration and the sudden infant death syndrome.

Global serum levels of IgE (PRIST, Phadebas) and specific anti-cow's milk IgE (RAST) were measured in populations of infants with a history of one or more episodes of milk aspiration (n = 12), victims of the sudden infant death syndrome (SIDS) (n = 18), "near miss" SIDS infants (n = 23), siblings of a SIDS victim ((n = 21) and control infants (n = 38). Only the infants with a past history of milk aspiration had significantly raised global and specific IgE. The absence of raised specific IgE in the subjects who died from SIDS argues against the hypothesis of sensitisation to cow's milk proteins during a previous episode of aspiration. Nasopharyngeal reflux is frequently seen in near-miss infants. This reflux is more often responsible for reflex apnoea due to stimulation of the laryngeal chemo-receptors than to a fatal aspiration.

Animals↗
PubMedDate not supplied

A validation study using the case-control method of the nursing diagnosis high risk for aspiration.

PURPOSE: To develop further the nursing diagnosis risk for aspiration by determining risk factors present in patients who aspirated. METHODS: The case-control design was used to compare cases (n = 131) and controls (n = 206) on past and present exposures thought to be risk factors for aspiration. Data were analyzed using univariate and multiple logistic regression. FINDINGS: The following risk factors were statistically significant and comprise the final model: altered level of consciousness, metoclopramide (known to accelerate gastric emptying), vomiting, seizures, and unable to change own position. CONCLUSIONS: The risk factors of altered level of consciousness and delayed gastric emptying are currently included in the NANDA taxonomy for the nursing diagnosis risk for aspiration. These risk factors are not included in the taxonomy: vomiting, seizures, and unable to change own position. Results of the study have been submitted to the Diagnosis Review Committee for consideration to further develop this diagnosis.

Analysis of Variance↗
PubMed2000

Impact of oral diseases on systemic health in the elderly: diabetes mellitus and aspiration pneumonia.

Evidence is increasing that oral health has important impacts on systemic health. This paper presents data from the third National Health and Nutrition Examination Survey (NHANES III) describing the prevalence of dental caries and periodontal diseases in the older adult population. It then evaluates published reports and presents data from clinical and epidemiologic studies on relationships among oral health status, chronic oral infections (of which caries and periodontitis predominate), and certain systemic diseases, specifically focusing on type 2 diabetes and aspiration pneumonia. Both of these diseases increase in occurrence and impact in older age groups. The NHANES III data demonstrate that dental caries and periodontal diseases occur with substantial frequency and represent a burden of unmet treatment need in older adults. Our review found clinical and epidemiologic evidence to support considering periodontal infection a risk factor for poor glycemic control in type 2 diabetes; however, there is limited representation of older adults in reports of this relationship. For aspiration pneumonia, several lines of evidence support oral health status as an important etiologic factor. Additional clinical studies designed specifically to evaluate the effects of treating periodontal infection on glycemic control and improving oral health status in reducing the risk of aspiration pneumonia are warranted. Although further establishing causal relationships among a set of increasingly more frequently demonstrated associations is indicated, there is evidence to support recommending oral care regimens in protocols for managing type 2 diabetes and preventing aspiration pneumonia.

Adolescent↗