Prevalence Of Aspiration Pneumonia Research Articles

Aspiration during Rapid Sequence Induction: Prevalence and Risk Factors.

BackgroundSecuring definitive airway with minimal complications is a challenging task for high-volume emergency departments (ED) that deal with patients with compromised airway.Materials and methodsWe conducted a prospective observational study between September 2019 and March 2020. Cohort of adults presenting to the ED requiring rapid sequence induction (RSI) were recruited to determine the prevalence and risk factors for the development of aspiration pneumonia(AP) in patients intubated in the ED.ResultsDuring the study period, a total of 154 patients with a mean age of 44.5 years required RSI in the ED. Male (61%) predominance was noted among the study cohorts. We did not find any association between RSI performed in the ED and the risk of developing AP. The first attempt success rate of RSI was 76.7%, and 33(21.4%) patients had immediate adverse events following RSI. Rescue intubation was required for 11(7.1%) patients. The prevalence of AP following RSI in the ED was 13.4%. Endotracheal tube (ET) aspirate pepsin was positive in 45(29.2%) samples collected. The ET aspirate pepsin assay had low sensitivity (44.44%), specificity (73.53%), positive predictive value (18%), and negative predictive value (91%) in predicting the occurrence of AP. On multivariate logistic regression analysis, male gender (AOR: 7.29, 95%CI: 1.51−35.03, p = 0.013) and diabetes mellitus (AOR: 3.75, 95%CI: 1.23-11.51, p = 0.02) were found to be independent risk factors for developing AP.ConclusionWe identified male gender and diabetes mellitus to be independent predictors of risk of developing AP after RSI in the ED. ET aspirate pepsin levels proved to be neither sensitive nor specific in the diagnosis of AP.How to cite this articleRoshan R, Sudhakar GD, Vijay J, Mamta M, Amirtharaj J, Priya G, et al. Aspiration during Rapid Sequence Induction: Prevalence and Risk Factors. Indian J Crit Care Med 2021;25(2):140–145.

Application of Cluster Nursing Among Post-Stroke Patients with Dysphagia

Objective: To explore the effect of cluster nursing care among post-stroke patients. Methods: Post-stroke patients with dysphagia (n=72) were randomly divided into two groups: experimental (or intervention) (n=36) the control (n=36). Patients in the experimental group were given cluster care, including swallowing assessment, safe eating guide, swallowing rehabilitation, the establishment of cluster prevention strategy and health education to patients and caregivers. Patients in the control group were given conventional nursing care, and the score of swallowing function, the prevalence of aspiration pneumonia and nursing care satisfactory level in both groups were assessed before and after the intervention. Results: The swallowing function of patients in the two groups were improved after intervention, but patients in the experimental group showed significantly higher improvement than the control group (P<0.05). The incidence of aspiration pneumonia was significantly lower in the experimental group compared to the control group (P<0.05). Moreover, the satisfactory level of nursing management was higher in the experimental group than the control group (P<0.05). Conclusion: Cluster nursing (CN) practice has significantly improved the swallowing function of stroke patients with dysphagia, reduced the incidence of aspiration pneumonia and enhanced the satisfaction of nursing care.

Two-Year Prevalence of Dysphagia and Related Outcomes in Head and Neck Cancer Survivors: An Updated SEER-Medicare Analysis

Using a national database, we aimed to examine prevalence of dysphagia at the population level in head and neck cancer (HNC) survivors. Surveillance, Epidemiology, and End Results (SEER)-Medicare data were retrospectively analyzed among 16,194 eligible HNC patients treated between 2002 and 2011. Claims were used to estimate prevalence of 3 swallowing-related endpoints within 2 years of treatment: dysphagia, stricture, and aspiration pneumonia and derive treatment- and site-specific estimates. Multiple logistic regression was conducted with stepwise backward selection. Dysphagia, stricture, and aspiration pneumonia were prevalent, occurring among 45.3% (95% CI: 44.5-46.1), 10.2% (95% CI: 9.7-10.7), and 8.7% (95% CI: 8.2-9.1) of all patients, respectively. Prevalence of aspiration pneumonia and stricture remained stable over the decade, but dysphagia increased by 11.7%. Prevalence of all swallowing-related endpoints was highest among those treated with chemoradiation. Relative to single modality surgery, single modality radiation was associated with 2.1 (95% CI: 1.8-2.4), 1.3 (95% CI: 0.97-1.6), and 1.4 (95% CI: 1.1-1.8) greater odds of dysphagia, stricture, and aspiration pneumonia respectively. Relative to single modality RT, multimodality surgery+RT or CRT was associated with 1.5 (95% CI: 1.3-1.7), 1.7 (95% CI: 1.4-2.1), and 1.2 (95% CI: 0.95-1.5) or 2.9 (95% CI: 2.5-3.3), 2.3 (95% CI: 1.9-2.8), and 1.6 (95% CI: 1.3-2.0) greater odds of dysphagia, stricture, and aspiration pneumonia, respectively. Relative to multimodality surgery+RT, CRT was associated with 1.9 (95% CI: 1.7-2.2), 1.3 (95% CI: 1.1-1.5), and 1.3 (95% CI: 1.1-1.6) greater odds of dysphagia, stricture, and aspiration pneumonia respectively. Prevalence of dysphagia, stricture, and aspiration pneumonia were similar in the decade studied (2002 to 2011) when comparing to published rates using similar methodology in an earlier decade (1992-1999), suggesting persistence of this morbidity in the decade in which IMRT was popularized.

Clinical Significance of Aspiration Pneumonia and Diffuse Aspiration Bronchiolitis in the Elderly

Aspiration Pneumonia (AP) and Diffuse Aspiration Bronchiolitis (DAB) are often found in elderly, debilitated patients with dysphagia. The prevalence of AP in hospitals and nursing homes is rapidly expanding. The incidence of AP to total pneumonia is very high in elderly patients aged 70 years and older. For the diagnosis of AP or DAB, the evaluation of swallowing function is important. Food aspiration alone may cause DAB, but not always cause AP. Two different therapeutic approaches such as antibiotics administration and swallowing rehabilitation with oral hygiene are necessary for the cure of AP. Drugs that improve the swallowing reflex, vaccinations and oral health care management are effective in preventing aspiration pneumonia; however, percutaneous endoscopic gastrostomy is not recommended for the purpose of preventing aspiration pneumonia. The proper management of AP and DAB may be a central issue of geriatric medicine.

Cough throughout life: Children, adults and the senile

We review cough from premature birth, mature neonatal life, in childhood and adult life, and in old age. There is a regrettable lack of definitive studies, but many clues in the literature. The cough reflex seems weak in premature infants, but develops with maturity. It is pronounced in childhood, but there seem to be no studies comparing its strength then with that in adulthood. In old age the cough may weaken, as indicated by the prevalence of aspiration pneumonia. These changes are presumably related to the development and degeneration of the afferent and central nervous pathways for cough, which may be reflected in the changes in laryngeal muscle function with age. There is much evidence that age influences the development of the respiratory system in general, and of the immune system which would affect the degree, frequency and clinical issues of cough. Other factors that limit our understanding of the changes in cough with age include the reporting of cough by parents in infants and carers in old age and the use of different diagnostic criteria throughout life. Age-related variation in cough sensitivity seems to be well established, but its quantitation and mechanisms require much further research.

The Hyoid Bone in Malay Infants with Cleft Lip and Palate

To compare morphological and positional variations of the hyoid bone in unoperated infants with cleft lip and palate (CL/P) with those in noncleft infants. Retrospective, cross sectional. Three-dimensional computed tomography scans were obtained from 29 unoperated CL/P infants of Malay origin aged between 0 and 12 months and from 12 noncleft infants in the same age range. Observations were made and measurements were obtained with a software package developed at the Australian Craniofacial Unit. The sizes of the hyoid bones and the position of the hyoid body and epiglottis in relation to the cervical spine were measured. Anatomical anomalies of the hyoid and prevalence of aspiration pneumonia were also documented. The hyoid bones and epiglottis were found to be located more inferiorly in CL/P infants compared with the noncleft infants. Also, 17% (5/29) of the CL/P infants had nonossified hyoid bodies. The results suggest that there are differences in the location and genesis of the hyoid bone in infants with CL/P that warrant further investigation.

Epidemiology and impact of aspiration pneumonia in patients undergoing surgery in Maryland, 1999-2000.

The epidemiology of aspiration pneumonia and its impact on clinical and economic outcomes in surgical patients are poorly defined. We sought to identify preoperative patient characteristics and surgical procedures that are associated with an increased risk for aspiration pneumonia and to determine the clinical and economic impact in hospitalized surgical patients. Observational study using a state discharge database. All hospitals in Maryland. We obtained discharge data for 318,880 adult surgical patients in 52 Maryland hospitals from January 1, 1999, through December 31, 2000. The primary outcome variable was a discharge diagnosis of aspiration pneumonia. Unadjusted and adjusted analyses were performed to identify patient characteristics and surgical procedures associated with an increased risk for aspiration pneumonia and to determine the impact on intensive care unit admission, in-hospital mortality, hospital length of stay, and total hospital charges. The overall prevalence of aspiration pneumonia was 0.8%. The prevalence varied among hospitals (range, 0% to 1.9%) and by surgical procedure (range, <0.1% to 19.1%). Patient characteristics independently associated with an increased risk included: male sex, nonwhite race, age of >60 yrs vs. 18-29 yrs, dementia, chronic obstructive pulmonary disease, renal disease, malignancy, moderate to severe liver disease, and emergency room admission. In patients undergoing procedures other than tracheostomy, aspiration pneumonia was independently associated with an increased risk for admission to the intensive care unit (odds ratio, 4.0; 95% confidence interval, 3.0-5.1), in-hospital mortality (odds ratio, 7.6; 95% confidence interval, 6.5-8.9), longer hospital length of stay (estimated mean increase of 9 days; 95% confidence interval, 8-10), and increased total hospital charges (estimated mean increase of 22,000 US dollars; 95% confidence interval, 19,000 US dollars-25,000 US dollars). Aspiration pneumonia occurs in approximately 1% of surgical patients and is associated with significant morbidity, mortality, and costs of care. Given that the rate of aspiration pneumonia varies among hospitals, we can improve the quality and reduce the costs of care by implementing strategies to reduce the rate of aspiration pneumonia.