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Journal of the American Dental... Sep 2014
Topics: Deglutition; Dental Prosthesis; Female; Foreign Bodies; Humans; Male; Respiratory Aspiration
PubMed: 25169996
DOI: 10.1016/s0002-8177(14)60139-2 -
Journal of Clinical Anesthesia Aug 2024
Topics: Humans; Hypoglycemic Agents; Acidosis; Perioperative Period; Respiratory Aspiration; Perioperative Care
PubMed: 38460414
DOI: 10.1016/j.jclinane.2024.111416 -
Current Opinion in Otolaryngology &... Jun 2020The use of commercially or naturally thickened liquids is a well-established treatment for patients with dysphagia to fluids, the aim of which is to improve swallow... (Review)
Review
PURPOSE OF REVIEW
The use of commercially or naturally thickened liquids is a well-established treatment for patients with dysphagia to fluids, the aim of which is to improve swallow safety by minimizing risk of aspiration. Although the most recent systematic reviews conclude that this treatment lacks evidential support and leads to patient-reported worsening health and quality of life, thickened liquids continue to be used with patients with dysphagia across clinical settings. This review briefly summarizes the evidence and considers potential reasons for the apparent mismatch between the evidence and clinical practice.
RECENT FINDINGS
Continuing practice with thickened liquids is influenced by a range of factors, including gaps in clinical knowledge, inadequate patient involvement, a culture of common practice and a reliance on invalid surrogate studies or research lacking a credible association between thickened liquids and clinically meaningful endpoints.
SUMMARY
While awaiting further research, clinical decision-making about thickened liquids can be improved by considering the evidence of clinically meaningful endpoints, promoting shared decision-making with patients and underpinning practice with knowledge about the complex relationship between dysphagia, aspiration and pneumonia.
Topics: Administration, Oral; Clinical Decision-Making; Deglutition; Deglutition Disorders; Humans; Respiratory Aspiration; Solutions; Viscosity
PubMed: 32332203
DOI: 10.1097/MOO.0000000000000622 -
The Laryngoscope Aug 2018To determine the prevalence of silent aspiration in pediatric patients and identify which diagnoses may be associated with this finding.
OBJECTIVE
To determine the prevalence of silent aspiration in pediatric patients and identify which diagnoses may be associated with this finding.
METHODS
An institutional review board-approved retrospective review was conducted for all patients under the age of 18 who underwent modified barium swallow (MBS) studies at a tertiary children's hospital in 2015. Speech-language pathologists reviewed MBS studies to identify aspiration/silent aspiration on each fluid consistency tested. Charts were reviewed to collect demographic information and the otolaryngologic, neurologic, genetic, and syndromic diagnoses of each patient.
RESULTS
Among 1,286 patients who underwent MBS, 440 (34%) demonstrated aspiration. Within the aspiration group, 393 (89%) specifically demonstrated silent aspiration. Thin fluids were silently aspirated in 81% of these patients. Of children aged <6 months, 41% were found to aspirate and, of those, 95% silently aspirated. Median age at which patients demonstrated silent aspiration was 1.1 years. Silent aspiration was documented in 41% of patients with laryngeal cleft, 41% of patients with laryngomalacia, and 54% of patients with unilateral vocal fold paralysis. Laryngeal cleft, laryngomalacia, unilateral vocal fold paralysis, developmental delay, epilepsy/seizures, syndrome, and congenital heart disease were all associated with silent aspiration.
CONCLUSION
Silent aspiration may be associated with a number of underlying conditions and is more common than previously described. Caregivers and clinicians should be aware that the absence of cough does not eliminate the possibility of aspiration. Modified barium swallow studies can reveal silent aspiration, which is difficult to detect on clinical feeding evaluation. Modified barium swallow findings can guide feeding therapy and the overall management of aspiration.
LEVEL OF EVIDENCE
4. Laryngoscope, 1952-1957, 2018.
Topics: Barium Sulfate; Child, Preschool; Deglutition Disorders; Female; Humans; Infant; Male; Respiratory Aspiration; Retrospective Studies; Risk Factors
PubMed: 29280496
DOI: 10.1002/lary.27070 -
Esophagus : Official Journal of the... Jul 2020Gastro-esophageal reflux disease (GERD) can present with typical or atypical or laryngo-pharyngeal reflux (LPR) symptoms. Pulmonary aspiration of gastric refluxate is...
BACKGROUND
Gastro-esophageal reflux disease (GERD) can present with typical or atypical or laryngo-pharyngeal reflux (LPR) symptoms. Pulmonary aspiration of gastric refluxate is one of the most serious variants of reflux disease as its complications are difficult to diagnose and treat. The aim of this study was to establish predictors of pulmonary aspiration and LPR symptoms.
METHODS
Records of 361 consecutive patient from a prospectively populated database were analyzed. Patients were categorized by symptom profile as predominantly LPR or GERD (98 GER and 263 LPR). Presenting symptom profile, pH studies, esophageal manometry and scintigraphy and the relationships were analyzed.
RESULTS
Severe esophageal dysmotility was significantly more common in the LPR group (p = 0.037). Severe esophageal dysmotility was strongly associated with isotope aspiration in all patients (p = 0.001). Pulmonary aspiration on scintigraphy was present in 24% of patients. Significant correlation was established between total proximal acid on 24-h pH monitoring and isotope aspiration in both groups (p < 0.01). Rising pharyngeal curves on scintigraphy were the strongest predictors of isotope aspiration (p < 0.01).
CONCLUSIONS
Severe esophageal dysmotility correlates with LPR symptoms and reflux aspiration in LPR and GERD. Abnormal proximal acid score on 24-h pH monitoring associated with pulmonary aspiration in reflux patients. Pharyngeal contamination on scintigraphy was the strongest predictor of pulmonary aspiration.
Topics: Adult; Aged; Data Management; Esophageal Motility Disorders; Esophageal pH Monitoring; Female; Gastroesophageal Reflux; Humans; Laryngopharyngeal Reflux; Male; Manometry; Middle Aged; Predictive Value of Tests; Prospective Studies; Radionuclide Imaging; Respiratory Aspiration; Severity of Illness Index
PubMed: 32086701
DOI: 10.1007/s10388-020-00726-9 -
American Journal of Surgery Oct 2022Foreign body aspiration (FBA) can be encountered in all age groups, especially in children under 3 years of age. In this study, we aimed to evaluate our results in...
OBJECTIVE
Foreign body aspiration (FBA) can be encountered in all age groups, especially in children under 3 years of age. In this study, we aimed to evaluate our results in children and adults who underwent rigid bronchoscopy due to a history of foreign body aspiration.
MATERIALS AND METHODS
In a single-center study, 822 consecutive patients with suspected foreign body aspiration and undergoing rigid bronchoscopy between January 2000 and August 2021 in our clinic were retrospectively evaluated.
RESULTS
There were 451 (54.9%) male and 371 (45.1%) female patients. The mean age was 8.1 ± 14.0 (range 1 month-84 years). 525 (63.9%) of the cases consisted of cases under 3 years old, including 3 years old. There were 726 (88.3%) pediatric patients (≤18 years old), and 96 (11.7%) adult patients. The most important symptoms were cough in 690 (83.9%) cases and wheezing in 492 (59.9%) cases. The most frequently aspirated foreign bodies in children were sunflower seeds (14.2%, n = 71), food particles (11.4%, n = 57) and needles (52%, n = 10.4). The most frequently aspirated foreign bodies in adults were needles (39.5%, n = 28), non-needle metallic objects (21.1%, n = 15) and food particles (11.3%, n = 8). No mortality was observed in any of the patients who underwent rigid bronchoscopy.
CONCLUSION
FBA is higher in children and direct radiological findings are less than in adults. Current findings show that FBAs in children are more difficult to diagnose and more dangerous clinically.
Topics: Adolescent; Adult; Bronchi; Bronchoscopy; Child; Child, Preschool; Female; Foreign Bodies; Humans; Infant; Male; Respiratory Aspiration; Retrospective Studies
PubMed: 35641321
DOI: 10.1016/j.amjsurg.2022.05.032 -
Anesthesia and Analgesia Jan 2021Application of cricoid pressure (CP) during rapid sequence induction and intubation sequence has been a "standard" of care for many decades, despite limited scientific... (Review)
Review
Application of cricoid pressure (CP) during rapid sequence induction and intubation sequence has been a "standard" of care for many decades, despite limited scientific proof of its efficacy in preventing pulmonary aspiration of gastric contents. While some of the current rapid sequence induction and intubation guidelines recommend its use, other international guidelines do not, and many clinicians argue that there is insufficient evidence to either continue or abandon its use. Recently published articles and accompanying editorials have reignited the debate on the efficacy and safety of CP application and have generated multiple responses that pointed out the various (and significant) limitations of the available evidence. Thus, a critical discussion of available data must be undertaken before making a final clinical decision on such an important patient safety issue. In this review, the authors will take an objective look at the available scientific evidence about the effectiveness and safety of CP in patients at risk of pulmonary aspiration of gastric contents. We suggest that current data are inadequate to impose clinical guidelines on the use of CP because we acknowledge that currently there is not, and there may never be, a method to prevent aspiration in all patients. In addition, we reiterate that a universally accepted medical-legal standard for approaching the high-risk aspiration patient does not exist, discuss the differences in practice between the US and international practitioners regarding use of CP, and propose 5 recommendations on how future studies might be designed to obtain optimal scientific evidence about the effectiveness and safety of CP in patients at risk for pulmonary aspiration.
Topics: Airway Management; Cricoid Cartilage; Humans; Intubation, Intratracheal; Pressure; Respiratory Aspiration
PubMed: 31397697
DOI: 10.1213/ANE.0000000000004360 -
European Journal of Gastroenterology &... Apr 2017Capsule endoscopy (CE) has an excellent safety profile. Although retention is the most cited complication, capsule aspiration is less frequent and is often reported only... (Review)
Review
INTRODUCTION
Capsule endoscopy (CE) has an excellent safety profile. Although retention is the most cited complication, capsule aspiration is less frequent and is often reported only as isolated cases. This study represents a systematic effort to compile and scrutinize the available data on capsule aspiration to provide comprehensive and conclusive information on this CE complication.
MATERIALS AND METHODS
A systematic literature search was performed in PubMed, Embase and Chinese National Knowledge Infrastructure. The search terms used were 'capsule endoscopy' AND 'aspiration' (both terms searched as keyword and MeSH). We included case reports and/or series on capsule aspiration, as well as observational cohort studies that reported capsule aspiration among their complications/outcomes.
RESULTS
Thirty-four case reports with 37 cases of capsule aspiration were identified. A further four observational studies reported aspiration as part of a cohort of patients undergoing CE. 94.6% of aspirations occurred in elderly men. 87.1% had significant comorbidities. 59.5% had symptoms on aspiration, with cough reported most frequently. The most common location of aspiration was the right main bronchus. Half of the patients required intervention for capsule retrieval; bronchoscopy was the most common management, with good effect. There was a single fatality following capsule aspiration, not directly related to the procedure, and one case of aspiration pneumonia. Outcomes were good for all other patients. The estimated overall aspiration rate is 0.1%.
CONCLUSION
Although very rare and generally safely managed, capsule aspiration should be anticipated in certain patient groups and capsule administration should be approached with necessary precautions.
Topics: Bronchoscopy; Capsule Endoscopes; Capsule Endoscopy; Cough; Foreign Bodies; Humans; Lung; Respiratory Aspiration
PubMed: 28253209
DOI: 10.1097/MEG.0000000000000821 -
Critical Care Clinics Jan 2016Anesthesia complications in the parturient can be divided into 2 categories: those related to airway manipulation and those related to neuraxial anesthesia. Physiologic... (Review)
Review
Anesthesia complications in the parturient can be divided into 2 categories: those related to airway manipulation and those related to neuraxial anesthesia. Physiologic changes of pregnancy can lead to challenging intubating conditions in a patient at risk of aspiration. Neuraxial techniques are used to provide analgesia for labor and anesthesia for surgical delivery. Therefore, complications associated with neuraxial techniques are often seen in this population. In the event of maternal cardiac arrest, modification to advanced cardiac life support algorithms must be made to accommodate the gravid uterus and to deliver the fetus if return of maternal circulation is not prompt.
Topics: Airway Management; Anesthesia, Epidural; Anesthesia, Obstetrical; Anesthesia, Spinal; Cesarean Section; Contraindications; Delivery, Obstetric; Female; Heart Arrest; Hematoma, Epidural, Spinal; Humans; Hypotension; Nerve Block; Patient Positioning; Pregnancy; Pregnancy Complications; Respiratory Aspiration; Risk Assessment; Thrombocytopenia
PubMed: 26600441
DOI: 10.1016/j.ccc.2015.08.009 -
British Journal of Anaesthesia Aug 2021Gastric emptying may be delayed in patients with diabetes mellitus (DM). However, the incidence of full stomach in fasting patients with DM and their risk of pulmonary... (Review)
Review
BACKGROUND
Gastric emptying may be delayed in patients with diabetes mellitus (DM). However, the incidence of full stomach in fasting patients with DM and their risk of pulmonary aspiration under anaesthesia is not well understood.
METHODS
A scoping review was undertaken to map the literature on aspiration risk in DM. A search was conducted in seven bibliographic databases, including MEDLINE and Embase, for original articles that studied aspiration risk, gastric emptying, or gastric content and volume. Selection and characterisation were performed by two independent reviewers using a predefined protocol registered externally.
RESULTS
The search identified 5063 unique records, and 16 studies (totalling 775 patients with DM) were selected: nine studied gastric emptying and seven studied gastric content or volume. There were no studies reporting the incidence of aspiration in subjects with DM. All nine studies reported delayed emptying in patients with DM compared with healthy controls. Amongst the seven studies that compared gastric residual content/volume (GRV) in the perioperative period, five reported clinically negligible GRV in both patients with DM and controls, whereas two observed a higher incidence of 'full' stomach in patients with DM.
CONCLUSIONS
The evidence concerning the aspiration risk for surgical patients with DM is based on a limited number of studies, mostly unblinded, reporting physiological data on gastric emptying and gastric volume as surrogate markers of aspiration risk. Data on fasting gastric content and volume in patients with DM are limited and contradictory; hence, the true risk of aspiration in fasting patients with DM is unknown.
Topics: Anesthesia; Comorbidity; Diabetes Mellitus; Fasting; Gastric Emptying; Gastrointestinal Contents; Humans; Intraoperative Complications; Postoperative Complications; Respiratory Aspiration; Ultrasonography
PubMed: 34023055
DOI: 10.1016/j.bja.2021.04.008