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PubMed1989

Avoiding the risk of aspiration in intubated infants.

Aspiration is a potential problem in intubated infants who are fed enterally. In this prospective study, intubated preterm infants were fed orogastrically or oroduodenally. Aspiration was assessed by examining endotracheal aspirates for evidence of blue-colored dye. None of the babies had blue-colored endotracheal secretions when fed by either route. Heart and respiratory rates, blood pressure, and transcutaneous oxygen and carbon dioxide measurements were recorded at each interval of the study. There were no significant differences from baseline for these measurements. These findings indicate that there is no significant aspiration in intubated preterm infants who are fed by the orogastric or the oroduodenal route.

Coloring Agents↗

PubMed1989

Aspiration pneumonitis. Prevention and treatment.

Recognizing the factors that predispose patients to aspiration and identifying the patients who are susceptible to aspiration are the first steps in preventing aspiration pneumonitis. These steps should be followed by pharmacologic and physiologic management. Mechanical ventilatory support, bronchoscopy when indicated, and aggressive fluid management are essential when aspiration does occur.

Anesthesia, General↗

PubMed1989

Pulmonary disease in progressive systemic sclerosis. A complication of gastroesophageal reflux and occult aspiration?

Thirteen patients with progressive systemic sclerosis were studied to evaluate the possible role of gastroesophageal reflux as a contributing pathogenic factor in the pulmonary disease of the patients. The evaluation of all patients included fiberoptic esophagogastroduodenoscopy with biopsies of the esophagus, otolaryngologic evaluation, technetium Tc 99m sulfur colloid aspiration scan, pulmonary function testing, including the diffusing capacity for carbon monoxide (DLCO) test, and 24-hour intraesophageal pH monitoring with probes placed 5 and 15 cm above the lower esophageal sphincter. Eleven patients had microscopic and macroscopic evidence of proximal esophagitis, 12 patients had laryngeal changes suggestive of aspiration, and 12 patients had abnormal DLCO values. Using multiple regression analysis, the degree of DLCO impairment correlated with the proximal and distal reflux episodes and scores recorded by pH monitoring. There was direct and indirect evidence for proximal gastroesophageal reflux and aspiration in the majority of patients, and a distinct correlation between the severity of reflux and the severity of pulmonary disease. Aggressive antireflux therapy may be helpful in reducing the pulmonary damage due to aspiration in these patients.

Adult↗

PubMed1986

Aspiration pneumonia: a review.

The damage caused by aspiration depends on the volume, nature and pH of the aspirate and the type of pathogen involved. Aspirate with a pH below 2.5 is much more likely to be toxic than less acidic material. Anaerobic organisms are common pathogens, but aerobic bacteria frequently appear in the hospital setting. Steroids may be useful if administered within minutes of the aspiration. Lavage with large amounts of alkaline fluid has not proved helpful.

Anti-Bacterial Agents↗

PubMed1985

[Gastroesophageal reflux and nocturnal broncho-aspiration in chronic bronchopathies].

Although the relationship between chronic bronchopathies and gastro-esophageal reflux is known, the existence and role of nocturnal broncho-aspiration is controversial. 32 patients with chronic bronchopathy and 13 controls without digestive or respiratory symptoms were studied. Nocturnal broncho-aspiration was diagnosed by the demonstration of vegetable fibers in the morning expectorate and by the presence of radioactive pulmonary foci 15 hours following an isotopic meal. Vegetable fibers were found with equal frequency in both groups. On the other hand, positive pulmonary scintigraphy, reflecting nocturnal broncho-aspiration, was observed in 24 of the 32 patients (75%) and only in 2 of the 13 controls (15%) (p less than 0.001). Thus, broncho-aspiration is a frequent occurrence in chronic bronchopathies.

Adult↗

PubMed1979

Assessment of a technique for scintigraphic monitoring of pulmonary aspiration of gastric contents in asthmatics with gastroesophageal reflux.

Ten asthmatics with gastroesophageal reflux had scintigraphic evaluation of gastropulmonary aspiration. Five mCi of Tc99m sulfur colloid diluted in 50 ml of isotonic saline were administered by nasogastric tube at bed time and the lungs were imaged the following morning. Imaging in 20 studies yielded no evidence of gastropulmonary aspiration. Scintigraphic evaluation has previously been reported to demonstrate gastropulmonary aspiration in some patients with gastroesophageal reflux and pulmonary disease. This study indicates that the technique may lack adequate sensitivity or that gastropulmonary aspiration in asthmatics with gastroesophageal reflux occurs in only a small subgroup of these patients or at infrequent intervals and is difficult to detect.

Adult↗

PubMed1977

Pulmonary hypertension in the perinatal aspiration syndromes.

Ten patients clinically diagnosed as having perinatal aspiration syndromes were found to have pulmonary hypertension. These infants were either term or postmature babies and had the following characteristics: (1) systemic or suprasystemic levels of pulmonary artery pressure (range, 50 to 117 mm Hg); (2) a degree of pulmonary hypertension not related to the degree of aspiration evident on chest roentgenograms; (3) evidence of right-to-left shunting at the ductal or foramen ovale level; and (4) sustained severe hypoxemia despite 100% inspired oxygen concentration. The overall mortality for the group was 50%. Since these patients had marked clinical and physiologic similarities to patients previously reported as having the persistent fetal circulation syndrome (PFC), they were classified as having "PFC with aspiration." The existence of pulmonary hypertension should be suspected despite roentgenographic evidence of aspiration in any patient who also manifests the clinical characteristics of PFC because its treatment may alter the prognosis of such patients.

Birth Weight↗

PubMed1980

Adult aspiration pneumonia.

Aspiration pneumonia occurs in many clinical situations and has far-reaching pulmonary consequences. The chest radiograph may suggest or support the diagnosis. Aspiration of gastric contents leads to exudation of fluid into air spaces, causing an alveolar infiltrate. Although its radiographic pattern may suggest pulmonary edema, aspiration of gastric contents can be distinguished by a normal pulmonary capillary wedge pressure. Aspiration of particulate matter causes airways obstruction and atelectasis. Most commonly there is a shifting mixed infiltrate in the lower lobes.

Aged↗

PubMed1995

Preventing feeding-associated aspiration.

Aspiration and its sequela aspiration pneumonia are frequent complications associated with enteral feeding. The purpose of this article is to provide a framework for recognizing aspiration events, identifying at-risk patients, and developing research-based strategies to prevent aspiration.

Eating↗

PubMed1993

Aspiration pneumonia in stroke.

Aspiration pneumonia developed within 1 year in 29 of 60 stroke patients referred for videofluoroscopic evaluation of poststroke dysphagia and drawn from a total population of 304 acute stroke patients. The presence of vallecular pooling, piriform pooling, or bolus penetration to or through the true vocal cords on videofluoroscopy did not correlate with the development of aspiration pneumonia. Kinematic pharyngeal transit times did show a significant correlation with the development of aspiration pneumonia (time of first movement, p = .038; time of arrival of bolus at valleculae, p = .0008; time of return of epiglottis to resting position, p = .0001). Those patients with total kinematic pharyngeal transit times (Em) of less than 2.00 sec were at little or no risk for aspiration pneumonia (0%), those with 2.01 to 5.00sec at moderate risk (38.5%), and those with more than 5.00sec were at marked risk (90%).

Cerebrovascular Disorders↗

PubMed1993

[Prevention of aspiration in obstetric patients in Denmark].

Women about to undergo Caesarean section are especially prone to suffer from aspiration of acid gastric contents into the lungs during anaesthesia. Physiological changes in the pregnant patient make gastric emptying time unpredictable. It therefore seems prudent to establish procedures in order to minimize the risk of aspiration of gastric contents. This survey reveals that 25% of the obstetric-anaesthesiological departments in Denmark employ pharmacological prophylaxis for aspiration of acid gastric contents. This finding is in contrast to a similar survey in the United Kingdom, where 99 to 100% of the Caesarean sections are carried out under pharmacological prophylaxis for aspiration of acid gastric contents.

Adult↗

PubMed1996

Anaesthesia and aspiration pneumonitis.

Aspiration pneumonitis describes the inflammatory reaction of the lung parenchyma following contamination by stomach contents. It is an uncommon but potentially lethal complication of general anaesthesia. Protection of the airway from contamination has long been one of the fundamentals of safe anaesthetic practice. Aspiration pneumonitis was first recorded by John Snow in 1858 but not scientifically described until 1946 by Curtis Mendelson, an American obstetrician, who differentiated between the airway obstruction due to inhalation of solid material and aspiration of liquids which resulted in an intense inflammatory reaction of the lung tissue manifesting as bronchospasm, pulmonary oedema and hypoxia. He identified general anaesthesia as a major contributory factor due to the loss of protective airway reflexes and as a result of related animal studies suggested that the aspiration of acidic material resulted in severe pulmonary impairment.

Anesthesia, General↗

PubMed1997

[Aspiration pneumonitis; progress in understanding its acute pathophysiology and its therapy].

Aspiration of gastric contents has been a major cause of acute respiratory failure in adult patients, and its mortality has been very high. Current method of treatment is limited, but the pathogenesis of acid aspiration lung injury has been well studied. The lung injury can be divided into direct and secondary injury. Neutrophils are thought to be a primary mediator of the secondary lung and systemic organ injury. Various substances such as cytokines, complements, and arachidonic acid metabolites, which activate neutrophils, are produced in acid aspiration pneumonitis. In this article, the progress in research of the acute pathophysiology of acid aspiration pneumonitis is reviewed and the possibility of its application to therapy is discussed.

Anesthesia↗

PubMed1997

Chronic aspiration in children.

Chronic aspiration in children can cause life-threatening pulmonary consequences as well as multiple hospital stays and costly nursing requirements. Causes of aspiration vary widely and must be accurately assessed for treatment to be optimal. This disorder can be successfully controlled with a number of medical and surgical interventions. Rarely, children with severe neurologic disorders will continue to aspirate saliva despite treatment with voice-conserving measures. In cases of life-threatening aspiration, laryngotracheal separation can be lifesaving.

Anastomosis, Surgical↗

PubMed1998

Contemporary treatment options for meconium aspiration syndrome.

The presence of meconium in the respiratory tract causes atelectasis, hypoxemia, hypercapnia, persistent pulmonary hypertension, inflammatory changes, and surfactant inactivation. Prevention is the most important factor in the management of meconium aspiration syndrome and it includes both prenatal and postnatal care. Prenatal procedures include constant fetal heart rate monitoring during labor, examination of acid-base equilibrium in the capillary blood from the fetal scalp, and eventually amnioinfusion. Amnioinfusion is not a widely accepted care and further studies to confirm its benefits are required. Postnatal procedures include obligatory suction of the oral-pharyngeal cavity and nose before the first breath, and selective endotracheal suction only in depressed neonates or neonates born from thick meconium-stained amniotic fluid. Conventional therapy of meconium aspiration syndrome includes monitoring of vital functions, chest physiotherapy, site drainage, airway suction, oxygen supply, respiratory support, antibiotics, sedation, normal fluid balance and calories intake, and when indicated, agents stabilizing blood pressure and heart rate. New management methods of meconium aspiration syndrome, not recommended as standard procedures at present include high-frequency oscillatory or jet ventilation as a lifesaving therapy, the use of exogenous surfactant, surfactant lavage of the bronchial tree, liquid ventilation, and inhalation of nitric oxide. Extracorporeal membrane oxygenation is of considerable importance in the treatment of the most severe meconium aspiration syndrome, but its role is diminishing with the development of other therapeutic methods.

Humans↗

PubMed1998

[Barium aspiration with fatal outcome].

A female patient died after aspiration of a barium-containing contrast medium as a result of ARDS in spite of intensive medical care. In cases of aspiration, the degree of aspiration should be documented by X-ray as soon as possible in order to decide upon the extent of specific suction measure. Lethalities after aspiration may be more frequent than can be assumed from the reports in the literature.

Barium Sulfate↗

PubMed2002

Free radicals in phacoemulsification and aspiration procedures.

OBJECTIVES: To detect free radicals in phacoemulsification and aspiration procedures using electron-spin resonance and to observe the effect of ophthalmic viscosurgical devices (viscoelastic agents) on free radical intensity. METHODS: (1) A test tube containing BSS Plus (Alcon Laboratories, Inc, Fort Worth, Tex) with 1% of the spin-trapping agent, 5,5'-dimethyl-1-pyrroline N-oxide, without irrigation and aspiration, was exposed to ultrasound (100% for 20 seconds). A preparation of hyaluronate sodium (Healon [a cohesive agent that contains 1% hyaluronate sodium] (Pharmacia, Uppsala, Sweden) or Viscoat [a dispersive agent that contains 3% hyaluronate sodium and 4% chondroitin sulfate] (Alcon Laboratories, Inc)) was added to the solution to observe inhibitory effects. (2) To simulate a clinical procedure, an eye model with irrigation and aspiration of a combination of 1% 5,5'-dimethyl-1-pyrroline N-oxide and BSS Plus, 25 mL/min, as the irrigating solution was exposed to ultrasound (for 10, 20, or 30 seconds). Healon or Viscoat was injected into the anterior chamber. Free radicals were measured by an electron-spin resonance spectrometer. RESULTS: (1) A characteristic signal corresponding to hydroxyl radicals was detected. Similar inhibition by Healon and Viscoat was observed. (2) Two ophthalmic viscosurgical devices similarly suppressed the signal at 10 seconds. The inhibition by Healon ceased at 20 seconds, whereas Viscoat suppressed the signal throughout the time course. CONCLUSIONS: Phacoemulsification produces hydroxyl radicals in the anterior chamber even with irrigation and aspiration. The effect of ophthalmic viscosurgical devices on free radicals depends on the retention of the materials within the anterior chamber. CLINICAL RELEVANCE: There are complications associated with phacoemulsification.

Anterior Chamber↗

PubMed1998

Image-guided fine-needle aspiration of the head and neck: five years' experience.

OBJECTIVE: To evaluate the diagnostic utility of image-guided fine-needle aspiration (FNA) in the head and neck. DESIGN: All image-guided FNAs of the head and neck performed January 1992 through June 1997 were included. All cytohistopathologic data were reviewed and collated. A slide review was performed in all cases with cytohistologic discrepancies. SETTING: The Department of Radiology, University of Pennsylvania Medical Center, Philadelphia. PATIENTS: Patients with deep-seated or poorly localized masses in the head and neck, representing both primary or recurrent/metastatic lesions, were referred. RESULTS: There were 111 computed tomography-guided FNAs performed in 109 patients. Sites sampled included parapharyngeal (n = 20), parotid or submandibular (n= 25), thyroid (34), and neck, paratracheal/paraesophageal, skull base, and paraspinal (n = 32). Diagnostic samples were obtained in 93 cases (83.8%). The procedures were well tolerated, without long-term complications. Cytologic examination detected a total of 39 malignancies, 24 of which were confirmed histologically. Eleven of the remaining malignant FNA cases reflected recurrent tumor; there were 3 false-positive FNA cases (2.7%), 2 in the setting of previous surgery and/or radiation therapy. There were 2 false-negative aspirates from sites deep in the neck (1.8%) among 7 of the 35 patients with benign aspirates who underwent surgery. Twenty six patients underwent ultrasound-guided FNA (thyroid gland only), revealing 1 papillary carcinoma and 1 intrathyroidal parathyroid gland, both of which were confirmed histologically. The findings in the aspirates from the rest of the patients were benign (n = 18), Hurthle cell neoplasm (n = 1), and nondiagnostic (n = 5). CONCLUSIONS: (1) The cytologic findings were supported clinically and/or histologically in 86 (92%) of the 93 diagnostic computed tomography-guided FNA cases. (2) Unnecessary surgery was avoided in 37% of the patients with recurrent tumor or benign diagnoses by cytologic assessment. (3) Potential pitfalls include false-positive diagnoses after radiation therapy and procedural or sampling limitations for deep neck and paraspinal lesions.

Adolescent↗