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Query: UMLS:C0010200 (cough)
 23,843 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Tracheobronchial suctioning is a routine practice frequently carried out in intensive care units (ICUs). It is required when the normal coughing mechanism is inadequate or disrupted; for example, where there is underlying respiratory or neurological disease, or where the cough is deliberately suppressed by sedative, muscle relaxants or anaesthetic agents while a patient is undergoing intermittent positive pressure ventilation. The procedure is carried out via a nasotracheal, orotracheal or tracheostomy tube. During the performance of this intervention, the skilled nurse is aware of the risks to which the patient is exposed and endeavours to prevent or minimise possible complications. In the following account of complications that may occur during or as a result of the procedure these have been classified as immediate, intermediate and later complications, as shown in Table 2. The purpose is to stimulate greater awareness of the hazards involved in this common everyday practice in intensive care units.
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PMID:Potential hazards of tracheobronchial suctioning. 148 22

The spread of influenza virus through a community typically causes large increases in medical visits for febrile respiratory disease. Increased school absenteeism occurs early in the epidemic, and school children appear to be important for disseminating the virus. Industrial absenteeism, hospitalizations of adults and infants for pneumonia, and deaths due to pneumonia-influenza all tend to peak later in the epidemic. Although influenza infection rates are highest in persons of school age, hospitalizations and deaths occur primarily in infants and in the elderly, particularly among those with pulmonary, cardiovascular, or other debilitating disorders. Influenza viruses can be spread by aerosol or contact. The primary target cells are those of the respiratory epithelium. In healthy adults, the typical influenza syndrome includes fever, cough, and general aches for three to seven days, but lassitude, cough, and evidence of small-airways disease may persist for weeks. Laryngotracheobronchitis, pneumonia, and unexplained fever are prominent manifestations of influenza that lead to hospitalization of young children. Adults are more likely to have complications of bacterial pneumonia and worsening of chronic pulmonary disease or congestive heart failure. Less frequent complications include myositis, various neurologic disorders, and Reye's syndrome. These consequences of influenza clearly justify strenuous efforts at prevention and control.
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PMID:Clinical manifestations and consequences of influenza. 359 13

During the 10 year period 1972-81, 39 patients with neurological disorders referred to a respiratory unit required artificial ventilation, seven on two occasions. The decision to undertake ventilation was usually made on clinical grounds because of deteriorating respiratory effort, ineffective cough, or inability to swallow. Arterial blood gas studies were of limited value in assessing the need for ventilation. The most frequent complication was bronchopulmonary infection which occurred in almost every patient, Staphylococcus pyogenes, Pseudomonas pyocyanea, and coliforms being the organisms most commonly isolated. In contrast, serious complications of tracheostomy and pulmonary thromboembolism occurred infrequently. There were 10 deaths among the 39 patients ventilated on 46 occasions; six were directly attributable to the neurological disease itself but four resulted from complications of artificial ventilation.
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PMID:Artificial ventilation for neurological disease: retrospective analysis 1972-81. 640 50

Most cases of sudden and temporary loss of consciousness [syncope] are caused by hypoperfusion of the formatio reticularis. more rarely by primary neurologic or metabolic disorders. The most common etiology is vasodepressor (vasovagal) syncope, which is caused by peripheral vasodilation due to acute withdrawal of the efferent sympathetic tone, while the parasympathetic outpour is increased at the same time. Although the efferent limb of the baroreflex manifests in a rather uniform way, the afferent parasympathetic limb is very variable, leading to a variety of clinical presentations and triggers (orthostatic hypotension, pain, fear, cough, micturition, emotions). While vasodepressor syncope mainly occurs in young people with healthy hearts, cardiac syncope caused by arrhythmias or obstructive lesions are more frequently found in elderly patients with organic heart disease. Neurogenic syncope comprises either primary neurologic disorders, such as epilepsia, or hypoperfusion of the vertebrobasilar system (TIA). Rarely, an acute increase of intracerebral pressure may cause syncope. Similarly, metabolic disorders or side effects of drugs are rare causes of syncope; however, drugs may act as important cofactors in the pathogenesis of syncope.
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PMID:[Sudden loss of consciousness: clinical presentation and pathophysiologic mechanisms]. 933 75

Urethral function can be assessed using many different techniques and this is very important when applied to women with neurological abnormalities. Urethral pressure profilometry, although not diagnostic for urethral sphincter incompetence, can be used to detect strictures and the ostia leading to urethral diverticula. Urethral instability may be recorded using urethral pressure catheters. The significance of this finding is uncertain but it has been suggested that women with urethral instability and detrusor instability are less responsive to therapy with anticholinergic drugs than those with a stable urethra. Micturition pressure profilometry is useful for determining obstruction during voiding and enables the site of obstruction to be determined. Leak point pressures (LPP) can be classified as detrusor or abdominal. Detrusor LPP are useful in patients with neurological disease. Abdominal LPP are subdivided according to the method used to increase intra-abdominal pressure either the Valsalva manoeuvre or coughing. The technique used to obtain an LPP can alter the measurement obtained and a standardized technique is essential for consistent results. LPP correlate with the urinary incontinence of women with genuine stress incontinence undergoing a pad test but is of no value if the woman does not leak! Tests of urethral function during bladder filling, stress and voiding phases help in assessing lower urinary tract dysfunction in neurourology.
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PMID:The urethra (UPP, MUPP, instability, LPP). 970 49

Legionnaire's disease is a life-threatening disease, observed in up to 15% of patients with pneumonia. Legionella pneumophila serogroup 1 is the most frequently implicated species among the genus Legionella. Legionella can cause two clinical pictures: Legionnaire's disease, a severe pneumonia, or Pontiac fever, a self-limiting disease. The attributable mortality of Legionnaire's disease is between 5-30%. Patients with typical Legionnaire's disease present with fever > 39 degrees C, cough and flu-like symptoms that do not respond to betalactam antibiotics. Neurological disorders may accompany severe cases. Laboratory findings include non-purulent sputum, increased liver enzymes and hyponatriemia. However, most patients do not fulfill all of these signs, symptoms and laboratory finding. Patients present with Legionella are frequently missed in the microbiology laboratory because clinicians do not ask for the specimen to be tested for Legionella. Established risk factors for Legionnaire's disease are chronic obstructive pulmonary disease (COPD), smoking and immunosuppressive therapy. New diagnostics tools such as the Legionella antigen in the urine, as well as PCR of a sputum sample allow rapid and accurate diagnosis. Such investigations are recommended for patients with severe pneumonia and those requiring hospitalization. State-of-the-art treatment includes a second generation macrolide, or alternatively, newer quinolones which are recommended as first-line drug for transplant patients. Prevention of Legionella requires a multi-faceted approach: The warm water should be kept at 60 degrees C in the boiler; the warm water should reach 50 degrees C at the faucet two minutes of opening the handle and the shower heads should be preferably made of stainless steel. In the hospital, the warm water supply should be free of Legionella at least for severely immunocompromised patients.
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PMID:[Legionelloses]. 1169 89

Swallowing is a complex motor event that is difficult to investigate in man. A slowed ability to eat a meal, loss of salivary control with drooling, episodic coughing, and choking and nasal regurgitation occurred due to the dysphagia. Swallowing disorders can be divided into oropharyngeal dysphagia and oesophageal dysphagia. The most common cause of oropharyngeal dysphagia is cerebrovascular accidents; other causes may include oropharyngeal structural lesions, systematic and local muscular diseases, and diverse neurologic disorders. Oesophageal dysphagia may result from neuromuscular disorders, mobility abnormalities, and intrinsic or extrinsic obstructive lesions. Initial evaluation of patients with suspected oropharyngeal dysphagia includes patient history, laryngological and neurological examination, and careful videofluoroscopic study of pharyngeal dynamics. Initial evaluation of patients with suspected oesophageal dysphagia includes patient history and barium swallow with oesophagography. Classifying dysphagia as oropharyngeal, oesophageal and obstructive, or neuromuscular symptom complexes leads to a successful diagnosis in 80% of patients.
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PMID:[The laryngological and neurological aspects of dysphagia]. 1696 13

A variety of neurological conditions and disease states are accompanied by pseudobulbar affect (PBA), an emotional disorder characterized by uncontrollable outbursts of laughing and crying. The causes of PBA are unclear but may involve lesions in neural circuits regulating the motor output of emotional expression. Several agents used in treating other psychiatric disorders have been applied in the treatment of PBA with some success but data are limited and these agents are associated with unpleasant side effects due to nonspecific activity in diffuse neural networks. Dextromethorphan (DM), a widely used cough suppressant, acts at receptors in the brainstem and cerebellum, brain regions implicated in the regulation of emotional output. The combination of DM and quinidine (Q), an enzyme inhibitor that blocks DM metabolism, has recently been tested in phase III clinical trials in patients with multiple sclerosis and amyotrophic lateral sclerosis and was both safe and effective in palliating PBA symptoms. In addition, clinical studies pertaining to the safety and efficacy of DM/Q in a variety of neurological disease states are ongoing.
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PMID:Therapeutic use of dextromethorphan: key learnings from treatment of pseudobulbar affect. 1743 20

Oropharyngeal aspiration (OPA) of food and fluids is known to be associated with pneumonia in dysphagic children with neurological disease and direct causality is often assumed. However, little is known about the relationship between OPA and pneumonia in medically complex children when other possible risk factors for pneumonia are considered. We examined the association of World Health Organization (WHO)-defined pneumonia in a heterogeneous group of children with swallowing dysfunction identified by a videofluoroscopic swallow study (VFSS). A retrospective chart review of 150 children (aged 2 weeks to 20 years) was undertaken to determine the relationship between pneumonia and (i) type of swallowing dysfunction (including OPA), (ii) consistency of aspirated food/fluid, and (iii) other factors including multisystem involvement and age (<or=1 year or >1 year). In univariate analysis, the odds ratio (OR) for pneumonia was significantly increased in children with post-swallow residue (PSR) (OR 2.5) or aspiration on thin fluids (OR 2.4), but not with aspiration of thick fluids or purees. In multi-logistic regression, type of swallowing dysfunction or aspirated food/fluid were no longer significant. Instead, pneumonia was significantly associated with diagnosis of asthma (OR 13.25), Down syndrome (OR 22.10), gastroesophageal reflux disease (GERD) (OR 4.28), or history of LRTI (OR 8.28), moist cough (OR 9.17) or oxygen supplementation (OR 6.19). Children with multisystem involvement demonstrated a higher association with pneumonia, but no difference was found for age. We conclude that the impact of OPA on development of pneumonia is considerably reduced once other factors in children with multisystem involvement are taken into account.
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PMID:Oropharyngeal aspiration and pneumonia in children. 1789 17

Clinical features and outcome of 2009 H1N1 influenza virus in the paediatric setting is ill-defined. The epidemiologic and clinical features of children with confirmed H1N1 influenza virus infection admitted to an Italian tertiary paediatric hospital from August through December 2009 were evaluated. A total of 63 children (mean age 4.3 years) were studied; of these, 29 (46%) had chronic underlying diseases. The most frequent symptoms and signs at admission were fever (97%), cough (60%) and respiratory disturbances (24%). Forty patients (63.5%) had H1N1-related complications: 32 (51%) pulmonary diseases, three (5%) neurological disorders, such as acute encephalitis or acute disseminated encephalomyelitis, and two (3%) haematological alterations. Three patients were admitted to the Intensive Care Unit. Most children (81%) were treated with oseltamivir: one developed rash during treatment; no other adverse events were noticed. All children survived without sequelae. In conclusions, 2009 H1N1 influenza virus infection in children is associated with a wide spectrum of clinical manifestations. Neurological disorders are not exceptional complications. Oseltamivir therapy seems safe also in infants.
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PMID:Clinical features of hospitalised children with 2009 H1N1 influenza virus infection. 2120 58


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