Treatment Of Aspiration Pneumonia Research Articles

Antibiotics versus Non-Antibiotic in the treatment of Aspiration Pneumonia: analysis of the MIMIC-IV database

BackgroundAspiration pneumonia (AP) is a common complication in the intensive care unit (ICU), which is associated with significantly increased morbidity and mortality and has a significant impact on patient prognosis. Antibiotics are commonly used in the clinical treatment of AP. However, the prognostic impact of antibiotics on patients with AP has not been adequately characterized. The purpose of this study is to illustrate the relationship between the use of antibiotics and in-hospital mortality of AP patients, as well as to analyze the effects of different antibiotic treatment regimens on the prognosis of the patients, and to further understand the distribution of pathogens and drug resistance in AP patients, so as to provide guidance information for the rational use of medication for patients in the clinic.MethodsClinical data of AP patients were extracted from the MIMIC-IV database. Statistical methods included multivariate logistic regression, propensity score matching (PSM), and inverse probability weighting (IPW) based on propensity scores to ensure the robustness of the findings. In addition, the characteristics of the medications used by patients with AP were described using statistical graphs and tables.ResultsA total of 4132 patients with AP were included. In-hospital mortality was significantly lower in the group using antibiotics compared to the group not using antibiotics (odds ratio [OR] = 0.44, 95% confidence interval [CI] 0.27- 0.71, P = 0.001). Furthermore, in the group using mechanical ventilation (MV), antibiotics use significantly reduced in-hospital mortality (OR = 0.30, 95% CI 0.15–0.57, P < 0.001).Vancomycin and cephalosporins are the most commonly used antibiotics to treat AP. Specifically, vancomycin in combination with piperacillin-tazobactam was used most frequently with 396 cases. The highest survival rate (97.6\\%) was observed in patients treated with levofloxacin combined with metronidazole. Additionally, vancomycin combined with piperacillin-tazobactam had many inflammation related features that differed significantly from those in patients who did not receive medication.ConclusionsAntibiotics use is closely associated with lower in-hospital mortality in ICU patients with AP. Moreover, understanding antibiotics use, the composition of pathogenic bacteria, and the rates of drug resistance in patients with AP can aid in disease prevention and prompt infection control.

Swallowing and Aspiration: How to Evaluate and Treat Swallowing Disorders Associated with Aspiration Pneumonia in Older Persons.

Aspiration pneumonia (AP) is the most severe complication of oropharyngeal dysphagia (OD). It is highly underdiagnosed and undertreated among older patients hospitalized with community-acquired pneumonia (CAP). Our aim is to review the state of the art in the diagnosis and treatment of swallowing disorders associated with AP. We performed a narrative review, including our experience with prior studies at Hospital de Mataró, on the diagnosis and treatment of AP. AP refers to pneumonia occurring in patients with swallowing disorders, frequently coinciding with poor oral health and vulnerability. Its main risk factors include oropharyngeal aspiration, impaired health status, malnutrition, frailty, immune dysfunction, and oral colonization by respiratory pathogens. Incidence is estimated at between 5 and 15% of cases of CAP, but it is highly underdiagnosed. Diagnostic criteria for AP have not been standardized but should include its main pathophysiological element, oropharyngeal aspiration. Recently, a clinical algorithm was proposed, based on the recommendations of the Japanese Respiratory Society, that includes aspiration risk factors and clinical evaluation of OD. To facilitate the task for health care professionals, new artificial intelligence (AI)-based screening tools for OD combined with validated clinical methods such as the volume-viscosity swallowing test (V-VST) for the detection of AP are being validated. Prevention and treatment of AP require multimodal interventions aimed to cover the main risk factors: textural adaptation of fluids and diets to avoid oropharyngeal aspiration; nutritional support to avoid malnutrition; and oral hygiene to reduce oral bacterial load. The diagnosis of AP must be based on standardized criteria providing evidence on the main etiological factor, oropharyngeal aspiration. Clinical algorithms are valid in the diagnosis of AP and the identification of its main risk factors. Combination of AI-based tools with V-VST can lead to massive screening of OD and save resources and improve efficiency in the detection of AP.

Delayed diagnosis and treatment of aspiration pneumonia can lead to increased risk of death

Delayed diagnosis and treatment of aspiration pneumonia can lead to increased risk of death

The current definition, epidemiology, animal models and a novel therapeutic strategy for aspiration pneumonia.

In the 21st century, aspiration pneumonia (ASP) is very common in older patients, and has a high mortality rate. ASP is diagnosed following confirmation of inflammatory findings in the lungs and overt aspiration or the existence of dysphagia. It is dominant in hospitalized community-acquired pneumonia (CAP), nursing and healthcare-associated pneumonia (NHCAP), and hospital-acquired pneumonia (HAP). The incidence of ASP is increasing every year. The human and experimental animal data revealed that micro-aspiration due to dysphagia during the night is the central mechanism of ASP. Therefore, the precise assessment of swallowing function is the key to diagnose ASP. From a therapeutic point of view, an appropriate administration of antibiotics, as well as a comprehensive approach for dysphagia plays a pivotal role in the prognosis and recovery from ASP. The non-pharmacologic approach, including swallowing rehabilitation and oral care, and a pharmacologic approach including ACE inhibitors and bronchodilators, are essential modalities for treatment and prevention of ASP. The clinical data of NHCAP provides us with a promising treatment strategy for ASP.

Evaluation of the Treatment of Aspiration Pneumonia in Hospitalized Children.

Aspiration pneumonia (AP) treatment is variable with limited available guidance on optimal antibiotic choice and duration. This study evaluated the impact of antibiotic regimen and duration on treatment failure for AP in children and correlated the effects of antimicrobial stewardship program (ASP) interventions on treatment duration. Hospitalized children who received antibiotics for AP were identified through an existing ASP repository. Diagnosis was confirmed through ASP documentation with either an international classification of diseases 9/10 code or physician diagnosis of AP. Incidence of treatment failure (necrotizing pneumonia, lung abscess, empyema, or retreatment) was compared between patients receiving shorter (≤7 days) vs longer (>7 days) course of antibiotics and between various empiric/final antibiotic regimens utilized. Duration of treatment was evaluated in patients with or without an ASP intervention. Four hundred and nineteen treatment courses for AP were included. Nineteen episodes (4.5%) of treatment failure were identified. No difference in treatment failure was observed between shorter vs longer courses (8 vs 11 episodes). An aminopenicillin plus beta-lactamase inhibitor was most frequently utilized for both empiric (47.2%) and final treatment (67.5%). Treatment failure rates did not differ with length of intravenous therapy nor empiric/final antibiotic regimen chosen. ASP interventions targeting duration were associated with significantly shorter courses (6.28 vs 7.46 days; P = .04). Shorter courses of antibiotics did not result in more treatment failure for AP when compared to longer courses. Neither antibiotic choice nor route impacted treatment failure rates. ASPs may optimize the treatment of pediatric AP.

Clinical Significance of Oral Care and Oral Management on the Treatment and Prevention of Aspiration Pneumonia in the Elderly: Evidences and Pitfalls

Oral care and oral management are important for preventing aspiration pneumonia (ASP). The main pathology of ASP is microaspiration of oropharyngeal contents during night, swallowing rehabilitation must be necessary for the ASP treatment. However, swallowing rehabilitation cannot totally restore the normal swallowing function. Oral healthcare management should be initiated and continued in parallel with antibiotic treatment of ASP. Oral care helps to prevent aspiration pneumonia by reducing oral bacteria, while oral management helps by improving masticatory and rehabilitating functions. The efficacy of oral care for reducing the incidence of pneumonia has been clearly observed in untreated frail elderly patients, but not in well-cared elderly persons. It has been established that oral care is cyclically significant for the prevention of ASP in the elderly. However, oral problems are not the primary cause of ASP in the elderly. Although there is an amount of evidences of oral care for ASP prevention, there are some controversies of the clinical significance of oral care for ASP treatment.

Pathophysiology and Treatment of Aspiration Pneumonia

Pathophysiology and Treatment of Aspiration Pneumonia

P39 CHYLOPTYSIS AFTER ESOPHAGECTOMY FOR ESOPHAGEAL CANCER; A RARE COMPLICATION

Abstract Aim We present a case of chyloptysis after esophageal resection for esophageal squamous cell cancer. Symptoms were caused by chylous casts occluding the airways. This necessitated surgical ligation of the main thoracic duct and sealing the airway fistula with a latissimus dorsi muscle flap. Background &amp; Methods Chyloptysis is rare and usually occurs spontaneously and secondary to disorders of the mediastinal lymphatic system. Chyloptysis manifests with the production of milky-white sputum or the formation and expectoration of bronchial casts. Initially no more than 20 cases have been reported in the literature (1,2). There are two mechanisms for the pathogenesis of chyloptysis: 1) congenital or acquired incompetence of the lymphatic valves and 2) occurrence of bronchopleural fistula in the context of chylous effusion (3,4). However, iatrogenic injury also can be a cause, in which injury to the thoracic duct leading to chylous pleural effusion with coexisting esofagotracheal fistula facilitates chyloptysis. Results A 66-year-old mal underwent a mini-invasive esophagectomy and gastric tube reconstruction for epidermoid cancer of the esophagus. Neoadjuvant chemo-radiation was given before operation. Post-operatively a minor chylous leak was managed by total parenteral nutrition for one week. He was discharged 15 days after operation. Four weeks after surgery he was readmitted because of fever, hypoxemia, wheezing, and expectoration of bronchial casts. He had fever, C-reactive protein level was 353 mg/l and white blood cell count 15.4 E9/l. He was intubated for respiratory failure and taken to ICU for treatment of aspiration pneumonia. Both chest x-ray and i.v. contrasted computed tomography (CT)of the chest confirmed bilateral aspiration pneumonia ( Figure 1). In bronchoscopy, occluding whitish mass was evacuated from both sides of the airways and this was thought to be because of aspiration (Figure 2). Infection responded to antibiotics and he was weaned from mechanic ventilation with tracheostomy until his symptoms recurred. Fiberoptic bronchoscopy revealed again milky-white sputum on both sides of the bronchial three. This time, a hole in the posterior tracheal wall was noticed and tracheal stent was applied to cover possible fistula to the esophagus or gastric conduit. However, in gastroskopy, such fistula could not be confirmed. Patient was under total parenteral nutrition (TPN) and after seven days since readmission, jejunal feeding was started. This caused a third deterioration period. Analysis of the bronchial aspiration revealed an elevated triglyceride level which was consistent with chyle and chylous fistula to the airways was therefore the most likely diagnosis. A right posterolateral thoracotomy was performed, and during surgery, thicker fibrous tissue was removed around the fistulae. Chylous reflux was observed form the fistula. Latissimus dorsi muscle flap was applied to cover the TEF and a main thoracic duct was controlled by ligating all soft tissue between descending aorta and azygous vein at the level of the diaphragm. After surgery, patient had TPN for 10 days. Enteral feeding was started to jejunal tube and we served a fat-free diet gradually increasing the fat content. Patient had tracheostomy and 2 weeks after operation he was noted to have recurrent TEF, and esophageal stent was applied. Postoperative recovery showed no further chyloptysis and he was discharged eventually 96 days after original operation. Conclusion Surgical ligation of thoracic duct resulted in complete resolution of chyloptysis. Surgery is the treatment of choice, although radiation therapy, chemotherapy, laser, and sclerosing agents have been described with varying success. To our knowledge, this is the first reported case of iatrogenic induced chyloptysis after esophageal resection.

Antibiotics for Aspiration Pneumonia in Neurologically Impaired Children.

To compare hospital outcomes associated with commonly used antibiotic therapies for aspiration pneumonia in children with neurologic impairment (NI). A retrospective study of children with NI hospitalized with aspiration pneumonia at 39 children's hospitals in the Pediatric Health Information System database. Exposure was empiric antibiotic therapy classified by antimicrobial activity. Outcomes included acute respiratory failure, intensive care unit (ICU) transfer, and hospital length of stay (LOS). Multivariable regression evaluated associations between exposure and outcomes and adjusted for confounders, including medical complexity and acute illness severity. In the adjusted analysis, children receiving Gram-negative coverage alone had two-fold greater odds of respiratory failure (odds ratio [OR] 2.15; 95% CI: 1.41-3.27), greater odds of ICU transfer (OR 1.80; 95% CI: 1.03-3.14), and longer LOS [adjusted rate ratio (RR) 1.28; 95% CI: 1.16-1.41] than those receiving anaerobic coverage alone. Children receiving anaerobic and Gram-negative coverage had higher odds of respiratory failure (OR 1.65; 95% CI: 1.19-2.28) than those receiving anaerobic coverage alone, but ICU transfer (OR 1.15; 95% CI: 0.73-1.80) and length of stay (RR 1.07; 95% CI: 0.98-1.16) did not statistically differ. For children receiving anaerobic, Gram-negative, and P. aeruginosa coverage, LOS was shorter (RR 0.83; 95% CI: 0.76-0.90) than those receiving anaerobic coverage alone; odds of respiratory failure and ICU transfer rates did not significantly differ. Anaerobic therapy appears to be important in the treatment of aspiration pneumonia in children with NI. While Gram-negative coverage alone was associated with worse outcomes, its addition to anaerobic therapy may not yield improved outcomes.

Aspiration pneumonia and pneumonitis: a spectrum of infectious/noninfectious diseases affecting the lung.

Our purpose is to describe aspiration pneumonia/pneumonitis as a spectrum of infectious/noninfectious diseases affecting the lung. We summarize diagnosis, risk factors, treatment, and strategies for prevention of aspiration. Aspiration is present in normal individuals, and disease manifestation depends on the chemical characteristics, frequency, and volume of inoculum. Anaerobes, though present, are no longer the predominant microbes isolated in aspiration pneumonia. Targets for preventing aspiration including improved oral hygiene and positional feeding have had mixed results. Patients diagnosed by clinicians with aspiration pneumonia experience greater morbidity and mortality than patients with community-acquired pneumonia. Aspiration pneumonia and pneumonitis are part of the pneumonia continuum and share similarities in pathophysiology, microbiology, and treatment. Modern microbiology demonstrates that the lung is not sterile, and isolates in aspiration pneumonia frequently include aerobes or mixed cultures. Treatment for aspiration pneumonia should include antibiotic coverage for oral anaerobes, aerobes associated with community-acquired pneumonia, and resistant organisms depending on appropriate clinical context. Additional studies targeting prevention of aspiration and investigating the increased morbidity and mortality associated with aspiration pneumonia are warranted.

AN UNUSUAL PRESENTATION OF TRACHEAL STENOSIS FOLLOWING 22 HOURS OF ENDOTRACHEAL INTUBATION IN A COCAINE ABUSER

SESSION TITLE: Critical Care 5 SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/09/2018 01:15 PM - 02:15 PM INTRODUCTION: Tracheal stenosis following intubation is a relatively rare but a serious problem. Thermal airway injury from cocaine inhalation resulting in tracheal stenosis has been rarely reported. We present an unusual case of tracheal stenosis in a cocaine abuser which developed following twenty two hours of endotracheal intubation. CASE PRESENTATION: An 18 year old female with history of depression was brought to the hospital due to acute encephalopathy secondary to suspected Benzodiazepine (BDZ) overdose. She was found unresponsive and was intubated for airway protection. This was her first intubation. She was also getting treatment for aspiration pneumonia. Urine toxicology tested positive for BDZ and cocaine. She was extubated the next day after her mentation improved. After 4 days, she went into respiratory distress associated with significant stridor. The possibility of bronchial asthma or allergic reaction to medication was sought. Emergency intubation was done to secure the airway but there was no apparent tongue swelling, vocal cord edema or paralysis. Because of persistent stridor despite of aggressive bronchodilator treatment, flexible bronchoscopy was done. It showed endotracheal circumferential growth (4-5 cm above carina) which narrowed 50% of the lumen. Biopsy from the growth was negative for viral, fungal and bacterial etiology. Tissue pathology showed fragments of fibrin, acute inflammatory changes suggestive of tracheal stenosis. Patient was transferred to higher level of care. She underwent cryotherapy and dilation of stenosis and was successfully extubated. DISCUSSION: Recent endotracheal intubation and history of cocaine inhalation are important risk factors for tracheal stenosis in our patient. It seems unlikely that trauma at the time of intubation induced tracheal stenosis. Another important risk factor is cocaine inhalation, which can cause thermal injury, mucosal damage to trachea and consequent tracheal stenosis. Thermal airway injury secondary to cocaine smoking may result from either (a) inhalation injury from chemical byproducts transported in the smoke, or (b) intratracheal combustion of highly inflammable solvents used in the production process. We think that cocaine inhalation initiated injury to mucosa and recent intubation aggravated development of tracheal stenosis. CONCLUSIONS: Tracheal stenosis should be kept in a differential diagnosis in patient with post extubation stridor who has history of cocaine abuse despite of short duration of intubation. Treatment options include cryotherapy, balloon tracheoplasty, laser therapy and surgery. Reference #1: Carlos S. Restrepo, MD, Jorge A. Carrillo, MD, Santiago Martínez, MD, Paulina Ojeda, MD, Aura L. Rivera, MD, and Ami Hatta, MD Pulmonary Complications from Cocaine and Cocaine-based Substances: Imaging Manifestations Reference #2: Post intubation tracheal stenosis, Sajal De and Sarmishtha De Reference #3: Taylor, RF and Bernard, GR. Airway complications from freebasing cocaine. Chest. 1989; 95: 476–477 DISCLOSURES: No relevant relationships by Muhammad Habib, source=Web Response No relevant relationships by Mohammad Islam, source=Web Response No relevant relationships by Manish Patel, source=Web Response No relevant relationships by Thien Vo, source=Web Response

誤嚥性肺炎の治療方針決定におけるプロカルシトニンの有用性(Procalcitonin utility for diagnosis and treatment of aspiration pneumonia)

要旨【目的】誤嚥性肺炎に対するプロカルシトニン（procalcitonin: PCT）の有用性を検討した。【対象】聖マリアンナ医科大学病院，東京ベイ・浦安市川医療センターの救急外来から誤嚥性肺炎で入院した成人患者で入院当日（第0病日）と第1病日のPCTがともに0.25ng/mL未満の場合は抗菌薬を投与せず，いずれかで0.25ng/mL以上の場合，抗菌薬を開始した。第4，7，10病日のPCT値の0.25ng/mL未満またはピーク値の10%未満への低下，あるいは担当医の判断で抗菌薬を終了した。【結果】患者は60人（男性26人），年齢中央値82歳［四分位範囲（interquartile range: IQR）71–89］，pneumonia severity index（PSI）は109.5（IQR 94–127）であった。第0，1病日のPCTがともに0.25ng/mL未満の14人（23.3%）は抗菌薬なしで全例治癒退院した。残り46人（76.7%）のうち1人を除く45人に抗菌薬が投与された。PCT値で抗菌薬を終了した患者が11人（24.4%），医師判断で抗菌薬を終了した患者が34人（75.6%），投与期間はそれぞれ7日（IQR 5.5–8），6.5日（IQR 5–7）で有意差は認めなかった。【結語】誤嚥性肺炎患者では入院初期のPCT陰性維持を根拠に安全に抗菌薬投与を制限できる可能性がある。

ОСОБЕННОСТИ ТУБЕРКУЛЕЗА У РЕБЕНКА С СОПУТСТВУЮЩЕЙ ПАТАЛОГИЕЙ

The clinical case demonstrated the intermittent course of primary tuberculosis caused by multiple drug resistant mycobacteria in 8 year old child with concurrent disorders of CNS and locomotor apparatus and living in the social institution of the closed type. The disease was detected in 2 years after the early period of primary tuberculous infection and administered preventive treatment by two anti-tuberculosis drugs. The disease was diagnosed during examination due to aspiration pneumonia with expressed clinical manifestations. Treatment of aspiration pneumonia and multiple drug resistant pulmonary tuberculosis was successfully completed.

Tentative nil per os leads to poor outcomes in older adults with aspiration pneumonia

Patients with aspiration pneumonia (AP) may experience swallowing function declines during treatment, necessitating artificial feeding methods. Proper AP treatment contributes to maintaining activities of daily living. The aim was to assess the effect of tentative nil per os (NPO) status on the recovery of AP patients and declines in their swallowing abilities. In this retrospective cohort study, 331 patients with AP having oral food intake in premorbid status were included after exclusions for reasons such as vomiting or respiratory insufficiency. We divided subjects into 2 groups: an early oral intake (EOI) group and a tentative NPO group according to the directions by the attending doctors at admission. We created a population model related to groupings from all subjects, which was a homoscedastic model without statistical differences by the inverse probability of treatment weighted (IPTW) method and compared outcomes between the groups. In the IPTW model, tentative NPO status resulted in poorer nutritional intake every day for 1 week from the date of admission (p<0.05), a significantly longer treatment duration (50% treatment length: NPO group, 13 days [95% confidence interval (CI), 12.04-13.96] and EOI group, 8 days [95% CI, 7.69-8.31[log-rank test, p<0.001]) and greater decline in swallowing ability over the course of treatment (p<0.001). Tentative NPO status with AP at hospital admission resulted in adverse effects on patients, including prolonged treatment duration and declines in swallowing ability. Avoiding unnecessary NPO might be another method to treat AP and contribute to the patient's outcomes in addition to medication administration.

Retrospective investigation of the clinical effects of tazobactam/piperacillin and sulbactam/ampicillin on aspiration pneumonia caused by Klebsiella pneumoniae

Klebsiella pneumoniae is an important causative bacterium of aspiration pneumonia in many elderly patients. We retrospectively investigated the clinical effects of the early treatment of aspiration pneumonia and background factors in 24 patients from whom Klebsiella pneumoniae was isolated. Sulbactam/ampicillin (SBT/ABPC) was selected for early treatment in 12 of the 24 patients diagnosed with aspiration pneumonia, and tazobactam/piperacillin (TAZ/PIPC) was selected for the other patients. The effective rates and success rates of early treatment were significantly higher in the TAZ/PIPC group than in the SBT/ABPC group (p = 0.003 and 0.027, respectively). Although no significant difference was noted because of the limited number of cases, the survival rates after 30 days were 91.7 and 58.3 % in the TAZ/PIPC and SBT/ABPC groups, respectively. Several bacteria isolated with Klebsiella pneumoniae were resistant bacteria, such as methicillin-resistant Staphylococcus aureus or Pseudomonas aeruginosa, and no anaerobe or extended-spectrum β-lactamase-producing Klebsiella pneumoniae was isolated. Thirteen and 11 of the 24 cases were classified as healthcare-associated pneumonia (HCAP) and hospital-acquired pneumonia (HAP), respectively, with no case classified as community-acquired pneumonia (CAP). As population aging progresses, the frequency of aspiration pneumonia classified as HCAP will increase. To cover anaerobes, it is necessary to select antibacterial drugs, such as TAZ/PIPC, for early treatment in consideration of resistant gram-negative bacteria to improve the outcome, and not drugs with weak activity against these bacteria.

Abstract P51: Aspiration Pneumonia is a Negative Predictor of Post-Stroke Level of Care: Findings From the UTHSC Houston Stroke Registry

Introduction: Aspiration Pneumonia (AsPNA) in acute stroke patients can lead to a three-fold risk in mortality. Treatment of AsPNA requires increased acuity of hospital care for antibiotic therapy and respiratory management. This care is provided at all levels, including Inpatient Rehabilitation (IR), Skilled Nursing Facility (SNF) or Sub-acute Care (Sub). There are limited studies assessing the role of AsPNA as an independent predictor of post-stroke disposition. Hypothesis: Low NIHSS is a predictor of higher functional status. We assessed the hypothesis that absence of AsPNA predicts post-stroke disposition to a functional level similar to low NIHSS. Methods: All patients admitted to the UT Stroke Service between January 2004 and October 2009 were included. Stratification occurred for age&gt;65, NIHSS and stroke risk factors. Using multivariate logistic regression, the data was analyzed for differences in post-stroke disposition among patients without aspiration pneumonia. Results: Home vs. Other Level of Care Of 3390 patients, 1668 were discharged home, 1722 to another level of care. Patients without AsPNA are 5.3 times more likely to be discharged home (P = &lt;.0001, OR 5.272, 95% CI 2.902 to 9.578). Patients with NIHSS &lt; 8 are 15.1 times more likely to be discharged home. IR vs. SNF Of 1547 patients, 983 patients were discharged to IR, 564 to SNF. Patients without AsPNA are 8.6 times more likely to be discharged to IR (P = &lt;.0001, OR 8.592, 95% CI 4.574 to 16.140). Patients with NIHSS &lt; 8 are 3.4 times more likely to be discharged to IR. SNF vs. Sub Of 739 patients, 564 were discharged to SNF, 175 to Sub. Patients without AsPNA are 5.5 times more likely to be discharged to SNF (P = &lt;.0001, OR 5.461, 95% CI 3.571 to 8.351). Patients with NIHSS &lt; 8 are 2.6 times more likely to be discharged to SNF. Conclusions: The absence of AsPNA is an independent predictor of improved post-stroke disposition. Patients with AsPNA have an increased likelihood of post-acute stroke care at a lower functional level, with a correlation stronger than NIHSS. This study is limited by its retrospective nature and unmeasured psychosocial factors related to discharge. Prospective studies on dysphagia screening, dietary modification and respiratory management are needed.

Effects of poisons on the level of applied amoxicillin i.v. with treatment of aspiration pneumonia caused by acute poisoning with drugs

Effects of poisons on the level of applied amoxicillin i.v. with treatment of aspiration pneumonia caused by acute poisoning with drugs

Cough in the elderly: A novel strategy for preventing aspiration pneumonia

Management of cough in the elderly with a deteriorated physical and mental status has received little focus. Since an aged population is rapidly increasing in developed countries, the research in this population are warranted. Cough reflex sensitivity in the elderly was shown to be hypersensitive, normosensitive and hyposensitive. The hypersensitive cough reflex is mostly due to gastro-esophageal reflux in nursing home patients. Impaired cough reflex sensitivity is assumed to play a crucial role in the development of pneumonia in the elderly. A marked depression of cough reflex sensitivity is reported in elderly patients with aspiration pneumonia. The impairment of the cough reflex in patients with aspiration pneumonia can involve both cortical facilitatory pathways for cough and medullary reflex pathways. We found the urge-to-cough in patients with aspiration pneumonia was also down-regulated, suggesting the involvement of supramedullary dysfunction in the etiology of aspiration pneumonia in the elderly. In order to prevent aspiration pneumonia in the elderly, restoration of cough reflex sensitivity is essential. We found several methods to restore cough reflex sensitivity in the elderly. They also improved the swallowing reflex, another important airway protective reflex, in the elderly. In the treatment of aspiration pneumonia, one of the most challenging steps is the start of eating for patients who usually fast at the time of hospitalization. By combining the methods to restore the cough reflex sensitivity and swallowing reflex, we developed a protocol to start eating in the elderly patients with aspiration pneumonia. Using the protocol, we reduced the incidence of re-aspiration due to start of eating in patients with aspiration pneumonia to one third of the patients without the protocol.

Are antibiotics indicated for the treatment of aspiration pneumonia?

Yes, for primary bacterial aspiration pneumonia and secondary bacterial infection of aspiration (chemical) pneumonitis, but not for uncomplicated chemical pneumonitis.

Aspiration pneumonia

Aspiration pneumonia is diagnosed upon confirmation of inflammatory findings in the lungs and overt aspiration (apparent aspiration) or a condition in which aspiration is strongly suspected (abnormal swallowing function and dysphagia). In hospital-acquired pneumonia, this occurs as one consequence of frequent silent aspiration. In the diagnosis of aspiration pneumonia, evaluation of the risk of silent aspiration during the night and evaluation of swallowing function are important. The causative microorganisms in aspiration pneumonia, similar to community-acquired pneumonia, are basically thought to be bacteria residing in the oral cavity, such as pneumococcus, Haemophilus influenzae, Staphylococcus aureus and anaerobes. Hospital-acquired aspiration pneumonia often occurs with no distinction between apparent and silent aspiration, and in many cases, aspiration of foreign substances is serious when dysphagia itself is severe. In the treatment of aspiration pneumonia, use of antimicrobials for the pneumonia itself and early measures to prevent aspiration are important.