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At least 19 recordsLinked to original sources
PubMed2006

[Diagnosis and therapy of aspiration pneumonia].

Aspiration pneumonia is an important and frequent complication following aspiration of infectious material from the oropharynx or stomach. Therefore the microbiological flora generally comprises a mixed spectrum of microbes including aerobic, microaerobic and anaerobic mircoorganisms. There are a number of risk factors for aspiration such as compromised consciousness or esophageal diseases. Aspiration pneumonia presents as a subacute or chronic disease. An endoscopic inspection of the bronchial system and a bacteriological evaluation should be performed in all patients. The principal therapeutic strategy for aspiration pneumonia is an antibiotic therapy. In uncomplicated cases a treatment for 7-10 days should be sufficient, but in case of complications like necrotizing pneumonia or lung abscess a prolonged administration (14-21 days, up to weeks or months) will be necessary. Recommended antibiotic regimens include clindamycin +/- cephalosporin, ampicillin/sulbactam and moxifloxacin.

Anti-Bacterial Agents↗
PubMed1997

New strategies for aspiration pneumonia.

Aspiration pneumonia is associated with decreases in both swallowing and cough reflexes and is the most common cause of death in the elderly. Basal ganglia strokes might predispose these patients to develop pneumonia owing to reductions of both reflexes, resulting in frequent aspiration during sleep. An impairment of dopamine metabolism in the basal ganglia is observed in these patients and levodopa administration improves the impaired swallowing reflex. Both swallowing and cough reflexes are mediated by endogenous substance P (SP) released from vagal sensory nerves in the pharynx and upper airways. The addition of a low dose of capsaicin to liquid or food, which stimulates the release of SP, may help prevent aspiration pneumonia. Angiotensin-converting enzyme inhibitor decreases SP catabolism resulting in improvements in both reflexes. Oral care and the sitting position after meals may decrease aspiration pneumonia in the elderly.

Aged↗
PubMed1998

[Outcome of repeated pulmonary aspiration in frail elderly. The Project Team for Aspiration Pneumonia].

Aspiration pneumonia is a major cause of death among frail elderly patients. Pulmonary aspiration is commonly reported in association with episodes of pneumonia, but the clinical significance and outcome in patients with recurrent pulmonary aspiration remain uncertain. We studied outcomes retrospectively in elderly patinents with recurrent aspiration. A total of 38 patients (M25, F13: mean age 81.4 yr) who were recognized to have undergone repeated aspiration were enrolled. Of them, 89.5% had suffered cerebrovascular disorder or other neurological disorders as the major underlying disease, and 63.2% showed moderate or severe cognitive impairment. Activities of daily living (ADL) were low and 97.4% were bedridden. At the time of enrollment, 79% had aspiration pneumonia or aspiration bronchitis. The mean number of admissions during the observation period was 2.3, and 60.9% of admissions were due to pneumonia. Of the patients obsered, 84.2% died during the observation period: the median survival time was 736 days. Major causes of death were pneumonia, respiratory failure, and asphyxia (65.6%). Percutaneous endoscopic gastrostomy (PEG) was carried out in 16 patients and these patients survived longer than patients who did not undergo PEG, although 75% of the PEG group died of pneumonia. We conclude that: 1) repeated pulmonary aspiration mostly occurrs with underlying diseases of cerebrovascular disorders, dementia, and deterioration of ADL, and 2) although the prognosis following repeated pulmonary aspiration was poor. PEG contributed to a longer survival, but did not prevent pneumonia.

Activities of Daily Living↗
PubMedDate not supplied

Review of current concepts in aspiration pneumonia.

Aspiration pneumonia is a form of ARDS resulting from an acid injury of the lung and is primarily a problem of arterial hypoxemia requiring adequate oxygen therapy. All other modes of therapy have not been shown to alter survival in man. In the otherwise healthy individual, immediate and long-term prognoses are excellent. However, in debilitated patients with significant underlying disease processes, rates of both immediate and delayed death are high. The late deaths reflect the significance of secondary infection due primarily to anaerobic organisms.

Adult↗
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↗
PubMed1988

Microbiological and clinical aspects of aspiration pneumonia.

Aspiration pneumonia is characterized by a pneumonitis in a dependent segment of the lung with typical necrosis or abscess-formation in the parenchyma. Observed aspiration or predisposition to aspiration, cavitation or abscess formation, with or without empyema fluid and isolation of distinctive micro-organisms are important clues to the diagnosis. Diagnostic procedures to collect anaerobic uncontaminated secretions are transtracheal aspiration, blood cultures, pleural fluid aspiration, fibreoptic bronchoscopic protected investigations and percutaneous transthoracic aspiration. Leading pathogens in more than 90% are anaerobic bacteria, mostly species of Bacteroides, Fusobacterium, Peptococcus and Peptostreptococcus; aerobic bacteria include Staphylococcus aureus and Gram-negative bacilli, mainly Klebsiella spp. and Pseudomonas aeruginosa. Treatment depends on bacteriological results; penicillin G and clindamycin are the most useful antibiotics against anaerobes and should be administered over a long period of time (4-12 weeks), adjusted to the clinical course of the individual patient.

Humans↗
PubMed1999

The role of anaerobes in patients with ventilator-associated pneumonia and aspiration pneumonia: a prospective study.

CONTEXT: Aspiration of oropharyngeal material, with its high concentration of anaerobic bacteria, has been implicated in the pathogenesis of both ventilator-associated pneumonia (VAP) and aspiration pneumonitis (AP). Consequently, patients with these disorders are usually treated with antimicrobial agents with anaerobic activity. OBJECTIVE: To determine the incidence of anaerobic bacteria in patients with VAP and AP. DESIGN: Prospective, nonrandomized, interventional study. SETTING: University-affiliated community teaching hospital. PATIENTS AND INTERVENTIONS: We performed sequential blind protected specimen brush (PSB) sampling and mini-BAL in 143 patients with 185 episodes of suspected VAP and 25 patients with AP who required mechanical ventilation. Quantitative aerobic and anaerobic cultures were performed on all specimens. Pneumonia was considered to be present when either > 500 cfu/mL cultured from blind PSB sampling or > 5,000 cfu/mL cultured from mini-BAL were present. RESULTS: Using the predefined criteria, bacterial pneumonia was diagnosed in 63 of 185 suspected VAP episodes (34%) and 12 of 25 patients with AP (48%). At least one dose of an antibiotic was given in the 24 h prior to bacteriologic sampling in 106 suspected VAP episodes (57%) and in 12 patients with AP (48%). More than one pathogen was isolated from 11 VAP and four AP patients. Pseudomonas aeruginosa, Staphylococcus aureus, and enteric Gram-negative organisms were isolated most frequently from patients with VAP. In the patients with AP, enteric Gram-negative organisms were isolated in patients with GI disorders and Streptococcus pneumoniae and Haemophilus influenzae predominated in patients with "community-acquired" aspiration. Only one anaerobic organism was isolated from the entire group of patients; Veillonella paravula was isolated from a blind PSB specimen in a patient with suspected aspiration pneumonia. CONCLUSION: Despite painstaking effort, we were able to isolate only one anaerobic organism (nonpathogenic) from this group of patients. The spectrum of aerobes in patients with VAP was similar to that reported in the literature. The organisms found in patients with AP was a reflection of the organisms likely to colonize the oropharynx. The use of antibiotics with anaerobic coverage may not be necessary in patients with suspected VAP and AP. Furthermore, penicillin G and clindamycin may not be the antibiotics of choice in patients with AP.

Aged↗
PubMed1991

Bilateral vocal cord teflon injection. An ineffective treatment for recurrent aspiration pneumonia.

Recurrent aspiration pneumonia is a potentially lethal problem, and its treatment is controversial. A variety of procedures have been advocated to prevent aspiration. These are reviewed briefly. We have been dissatisfied with established procedures because they usually require external approaches with considerable complexity and potential complications. Therefore, we attempted to obstruct the glottic airway by injecting both vocal cords with Teflon in a series of patients with recurrent aspiration pneumonia secondary to severe neurologic impairments. Since Teflon injection of the vocal cords bilaterally did not reliably prevent aspiration, we cannot recommend it for routine use in the treatment of chronic aspiration.

Humans↗
PubMed2002

[Prognostic factors associated with community-acquired aspiration pneumonia].

BACKGROUND: Aspiration pneumonia (AP) represents about 5-24% of community-acquired pneumonias. This condition mainly affects elderly patients and causes a high mortality. Our objective was to quantify the AP mortality rate and to identify prognostic factors upon patients admission. PATIENTS AND METHOD: We underwent a retrospective observational study of a cohort of AP patients admitted to a tertiary care hospital during a 29 months period. The in-hospital mortality rate was calculated. To identify prognostic factors, basal characteristics of patients as well as their clinical presentation and complementary tests performed on admission were studied and analyzed by univariate and multivariate techniques. Odds ratios and 95% confidence intervals were estimated. RESULTS: Thirty six out of 105 admitted patients with AP died (cumulative mortality incidence rate 34%, 95% CI 25-44%). In the univariate analysis, demographic, clinical and complementary test variables were associated with mortality. Final logistic model revealed the following independent variables: living in a nursing home (OR = 3.4; 95% CI 1.1-10.9), high degree of dependence (OR = 0.3; 95% CI, 0.1-0.9), body temperature (OR = 0.5 per Celsius degree; 95% CI, 0.3-1.0), serum creatinine levels (OR = 2.2 per mg/100 ml; 95% CI, 1.2-4.1) and LDH serum concentrations (OR = 1.5 per 100 IU/L; 95% CI, 1.1-2.0). CONCLUSIONS: The mortality of community-acquired AP is very high. In addition to clinical and biological parameters on admission such as body temperature and LDH and creatinine serum concentrations, living in a nursing home and having a high degree of dependence for the basic daily activities were identified as independent prognostic factors. An in-depth knowledge of prognostic factors related to pre-admission care and assistance is needed to decrease the mortality in these patients.

Activities of Daily Living↗
PubMedDate not supplied

Fine needle aspiration diagnosis of aspiration pneumonia (phytopneumonitis).

Aspiration pneumonia is defined as pulmonary infiltration caused by inhaled material, either solid or liquid, that is inherently toxic or that initiates a toxic response. We present the case of a solitary lung mass of unknown etiology in which cytology of a fine needle aspiration provided a definitive diagnosis of this disorder.

Aged↗
PubMed1980

Bacteriology of aspiration pneumonia in children.

Aspiration pneumonia in adults has been shown to involve anaerobes about 90% of the time. Studies of the bacteriology of aspiration pneumonia in children done in the past have either failed to exclude the oral and upper respiratory tract flora or have not utilized proper anaerobic culture techniques or both. In the present study. 74 institutionalized children with aspiration pneumonia were studied by percutaneous transtracheal aspiration. Their average age was 8 years. Fifty-two patients had pneumonitis, 12, necrotizing pneumonia, and 10, lung abscess. Only one patient (with lung abscess) had a complicating empyema. There was an average of five bacteria isolated per specimen--2.8 anaerobes and 2.2 nonanaerobes. The predominant anaerobic isolates were Gram-positive cocci, Bacteroides melaninogenicus, and fuso-bacteria; there were ten patients who yielded members of the Bacteroides fragilis group. The predominant nonanaerobes were alpha-hemolytic streptococci, Escherichia coli, Klebsiella pneumoniae, and Staphylococcus aureus. Thus, aspiration pneumonia in children, as in adults, commonly involves anaerobic bacteria. When aspiration occurs in a medical institution, nosocomial pathogens which are aerobic or facultative will also often be involved, in both children and adults.

Adolescent↗
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↗
PubMed1976

Aspiration pneumonia; incidence of aspiration with endotracheal tubes.

Aspiration has been suggested as a source of pulmonary complications seen in patients with tracheal intubation. A previous study demonstrated that the high incidence of aspiration in patients with tracheostomies can be decreased by modification of the tracheostomy tube cuff design. In the present protocol, 100 patients with endotracheal tubes in place were studied to document the incidence of aspiration and to attempt to decrease the incidence by modification of cuff design. Utilizing an Evans blue dye test to detect aspiration, 27 of the 48 patients (56%) with standard low volume, high pressure cuffed tubes had positive tests. In 17 patients with modified standard cuffed tubes, the incidence of aspiration was decreased to 29% (5 patients). Aspiration was further decreased to 20% (7 patients) in the 35 patients with high volume, low pressure cuffed tubes. These results demonstrate that the incidence of aspiration in patients with endotracheal tubes can be decreased by modification of endotracheal tube cuff design.

Adolescent↗
PubMed1993

[Aspiration pneumonia].

Pulmonary aspiration of stomach contents is a common clinical problem. Symptoms and consequences depend on the aspired volume, the pH and the content of food particles and bacteria. There are two phases following an aspiration of stomach contents into the lungs. The first phase is nonspecific and begins a few minutes after the aspiration. This phase is due to the chemical injury. The second phase is an inflammatory reaction. The reaction is haemorrhagic, granulocytic and necrotizing when the aspirate is acid (pH < 2.5). The presence of food particles causes granulomas. The immunological reactions are biphasic as well. The bacterial infection is mainly secondary to the chemical inflammation and occurs with an infection rate of 25-50%. The optimum management is symptomatic and should entail immediate endotracheal suction, aggressive ventilatory support with supplemental oxygen, CPAP or PEEP if indicated by clinical assessment and blood gas measurements, adequate fluid replacement and antibiotics if there is evidence of bacterial infection.

Humans↗
PubMed2002

[ACE inhibitors and its usefulness in the prevention of aspiration pneumonia in chronic cerebrovascular disease patients with asymptomatic swallowing dysfunction].

The double contrast pharyngogram by use of computed radiography (DCP-CR) has been found to be useful in detection of asymptomatic swallowing dysfunction. Following the DCP-CR examination, we investigated the incidence of aspiration pneumonia in 143 patients with chronic cerebrovascular disease (CVD) for 3 years and the effects of ACE inhibitors on the prevention of pneumonia. Aspiration pneumonia occurred in 29 out of 143 patients, and more frequently in the elderly chronic CVD patients with multiple brain lesions. Aspiration pneumonia was confirmed in 26 out of 85 patients (30.6%) with abnormal barium adhesion to the pharyngeal wall on the double contrast pharyngogram image by DCP-CR; whereas pneumonia occurred in 3 out of 58 patients (5.2%) with normal findings of DCP-CR pharyngogram. Among chronic CVD patients with abnormal findings of DCP-CR pharyngogram, the incidence of aspiration pneumonia was significantly lower in the patients treated with ACE inhibitors than in those treated with other antihypertensive agents or without antihypertensive agents (chi 2 value = 7.163, p < 0.05). Accordingly, ACE inhibitors may prevent the aspiration pneumonia and reduce the incidence of aspiration pneumonia in the chronic CVD patients with abnormal DCP-CR pharyngogram images.

Aged↗
PubMed2004

[The improvement of quality of life of patients with aspiration pneumonia after surgical therapy for intractable aspiration].

Sixteen patients with recurrent aspiration pneumonia that could not be controlled by appropriate medical therapies. These patients had no hope of recovering laryngeal function. Eight underwent laryngectomy, six underwent laryngotracheal separation and four underwent tracheoesophageal anastomosis. After surgery, we evaluated the efficacy of the therapy and the patients' satisfaction with therapy. Before and after surgery, the following clinical markers were examined to evaluate the efficacy of surgery: scores of aspiration pneumonia, WBC count, C-reactive protein, erythrocyte sedimentation rate, hematocrit, body mass index, total protein, albumin, and the Barthel index, an indicator of daily activity. Furthermore, the grade of Depression and mood, and satisfaction of patients and their carers among family members were scored using the Zung self-rating depression scale, a 20-picture face scale, the visual analog scale, and feeding status. After surgical therapy, we confirmed that aspiration was prevented in fourteen patients of sixteen, and the state of inflammation and nutrition, the state of depression and mood were improved. Thirteen patients from sixteen were able to ingest a meal orally. The quality of life of patients with intractable aspiration was improved.

Adult↗