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Query: UMLS:C0032290 (aspiration pneumonia)
 2,291 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Clinical studies have long suggested the presence of a specific cardiomyopathy in sickle cell anemia secondary to intracoronary thrombosis and subsequent infarction. Fifty-two autopsy patients were studied (48 with SS hemoglobin, 4 with S-C or S-Thal hemoglobin) to ascertain the range of cardiac pathologic abnormalities associated with this disease. The average age was 17 years (range 1 month to 48 years). Renal failure and infection were the most common causes of death; the former was a more common cause in adults than in children. Right and left ventricular hypertrophy and dilatation were the most common abnormal pathologic findings. No evidence of recent or remote myocardial infarction, coronary thrombosis or arteritis was noted in any patient. Eight patients who were studied with postmortem coronary arteriograms exhibited markedly increased coronary arterial caliber with no evidence of atherosclerosis. Seventeen of the 52 patients studied had clinical evidence of congestive heart failure before death. Of these 17 patients, 7 had moderate to severe left ventricular hypertrophy associated with chronic renal failure and hypertension, 2 had right ventricular hypertrophy with organized pulmonary thrombosis, 2 had rheumatic mitral valve disease and 2 died during the second trimester of pregnancy. Two of the 17 patients thought to have pulmonary edema before death in fact had aspiration pneumonia and hemorrhagic pneumonitis, respectively. The data suggest that cardiac dysfunction in sickle cell anemia can usually be explained by the adverse effect of coexisting disease on the diminished cardiac reserve of chronic anemia. The data do not support the concept of a specific "sickle cell cardiomyopathy".
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PMID:Clinicopathologic analysis of cardiac dysfunction in 52 patients with sickle cell anemia. 15 Jul 86

Ninety-eight cases of empyema thoracis admitted to Juntendo University Hospital between 1979 and 1990 were reviewed. Males accounted for 78 cases and females 20 cases. Thirteen pediatric patients ranged in age from 17 days to 4 years, while the 85 adult cases ranged from 16 to 89 years (mean: 58.4 years). The mortality rate increased with age. Fifty-three cases of community-acquired empyema thoracis consisted of 24 with no underlying disease (including 13 pediatric cases), and 29 with diabetes mellitus, alcoholic liver damage or chronic obstructive bronchopulmonary disease. Forty-five nosocomial empyema cases occurred after chest operation or thoracocentesis, or due to a subdiaphragmatic pathogenic condition or congestive heart failure complicated with aspiration pneumonia. In this series, 63 patients (64.3%) had para- or post-pneumonic empyema. Compared with the community-acquired infection cases, the mortality rate of the nosocomial infection cases was very high. Seventy-eight cases were culture-positive, including 3 positive for Mycobacterium tuberculosis. The remaining 20 cases were culture-negative. In 75 cases of culture-positive pleural fluid, aerobic bacteria were isolated from 31 cases (mortality rate: 22.6%), anaerobes mixed with aerobes from 21 cases (mortality rate: 52.4%), and anaerobes only from 23 cases (mortality rate: 21.7%). Thus, the mortality rate of mixed infected cases was highest. Anaerobes were frequently isolated from the community-acquired empyema cases, and were often found in para- or postpneumonic lesions, including aspiration pneumonia. The most commonly encountered aerobe was Staphylococcus aureus. Among the anaerobes, Bacteroides spp., microaerophilic streptococcus, Peptostreptococcus and Fusobacterium spp. were most common. A single organism was isolated in pure culture from 39 cases. Single organisms isolated from fluids were more frequently aerobes (25) than anaerobes (14). The cases harboring Bacteroides spp. showed the worst outcome, with 11 deaths in 25 such cases.
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PMID:[Analysis of 98 cases of thoracic empyema]. 178 10

A 20-month experience of mechanical ventilation (MV) in the newborn infants (birth weight greater than or equal to 1500 g) from a developing country is described. A total of 41 neonates (4.1% of total admissions to the Neonatal Intensive Care Unit) were treated with MV. The mode of MV was intermittent positive pressure ventilation and continuous positive airway pressure via nasotracheal intubation. The mean birth weight and gestational age were 2544 g and 36.2 weeks, respectively. The mean age at the start of MV was 141 h and the mean duration was 54 h. The indications for MV were respiratory distress syndrome (18), aspiration pneumonia (8), non-aspiration pneumonia (6), apnoea (8) and tetanus neonatorum (1). The complications encountered during MV were sepsis (26.8%), pulmonary haemorrhage (21.9%), congestive heart failure (17.1%), pneumothorax (14.6%) and intraventricular haemorrhage (7.3%). Post-extubation atelectasis was observed in 29.6% of cases. The overall survival rate was 43.9%. The risk factors for a poor outcome were birth weight less than 2000 g, prematurity and late referrals to the Neonatal Intensive Care Unit.
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PMID:Mechanical ventilation in newborn infants. 284 22

Corticosteroids are widely used as therapy for the adult respiratory distress syndrome (ARDS) without proof of efficacy. We conducted a prospective, randomized, double-blind, placebo-controlled trial of methylprednisolone therapy in 99 patients with refractory hypoxemia, diffuse bilateral infiltrates on chest radiography and absence of congestive heart failure documented by pulmonary-artery catheterization. The causes of ARDS included sepsis (27 percent), aspiration pneumonia (18 percent), pancreatitis (4 percent), shock (2 percent), fat emboli (1 percent), and miscellaneous causes or more than one cause (42 percent). Fifty patients received methylprednisolone (30 mg per kilogram of body weight every six hours for 24 hours), and 49 received placebo according to the same schedule. Serial measurements were made of pulmonary shunting, the ratio of partial pressure of arterial oxygen to partial pressure of alveolar oxygen, the chest radiograph severity score, total thoracic compliance, and pulmonary-artery pressure. We observed no statistical differences between groups in these characteristics upon entry or during the five days after entry. Forty-five days after entry there were no differences between the methylprednisolone and placebo groups in mortality (respectively, 30 of 50 [60 percent; 95 percent confidence interval, 46 to 74] and 31 of 49 [63 percent; 95 percent confidence interval, 49 to 77]; P = 0.74) or in the reversal of ARDS (18 of 50 [36 percent] vs. 19 of 49 [39 percent]; P = 0.77). However, the relatively wide confidence intervals in the mortality data make it impossible to exclude a small effect of treatment. Infectious complications were similar in the methylprednisolone group (8 of 50 [16 percent]) and the placebo group (5 of 49 [10 percent]; P = 0.60). Our data suggest that in patients with established ARDS due to sepsis, aspiration, or a mixed cause, high-dose methylprednisolone does not affect outcome.
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PMID:High-dose corticosteroids in patients with the adult respiratory distress syndrome. 331 54

To determine if there are any unique features of nursing home-acquired pneumonia we carried out a case-control study wherein each patient admitted with nursing home-acquired pneumonia was age- and sex-matched with a patient with community-acquired pneumonia. There were 36 men and 38 women in the nursing home group. The mean age of both groups was 74 years. The mortality rate for nursing home-acquired pneumonia it was 40.5%, whereas for community-acquired pneumonia it was 28% (P = NS). Patients with nursing home-acquired pneumonia had a significantly higher incidence of dementia and cerebrovascular accidents, and patients with community-acquired pneumonia were more likely to be smokers and to have chronic obstructive pulmonary disease. Aspiration pneumonia was more common among patients with nursing home-acquired pneumonia (P less than .001), and Hemophilus influenza pneumonia more common among the patients with community-acquired infection (P less than .01). Sputum for culture could be obtained in only 31 and 39% of the patients--contributory to the high rates of pneumonia of unknown etiology 63.5 and 56.1% for the nursing home group and the control subjects, respectively. Patients with nursing home-acquired pneumonia received cloxacillin and aminoglycosides more frequently than patients with community-acquired pneumonia (P less than .05), and patients with community-acquired pneumonia received erythromycin more frequently than patients with nursing home-acquired pneumonia (P less than .05). Complications were common during the hospital stay of these patients--the most frequent being congestive heart failure, urinary tract infection, renal failure, and respiratory failure.
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PMID:Nursing home-acquired pneumonia. A case-control study. 348 49

We report here our first experience with the use of a total artificial heart in a human being. The heart was developed at the University of Utah, and the patient was a 61-year-old man with chronic congestive heart failure due to primary cardiomyopathy, who also had chronic obstructive pulmonary disease. Except for dysfunction of the prosthetic mitral valve, which required replacement of the left-heart prosthesis on the 13th postoperative day, the artificial heart functioned well for the entire postoperative course of 112 days. The mean blood pressure was 84 +/- 8 mm Hg, and cardiac output was generally maintained at 6.7 +/- 0.8 liters per minute for the right heart and 7.5 +/- 0.8 for the left, resulting in postoperative diuresis and relief of congestive failure. The postoperative course was complicated by recurrent pulmonary insufficiency, several episodes of acute renal failure, episodes of fever of unidentified cause (necessitating multiple courses of antibiotics), hemorrhagic complications of anticoagulation, and one generalized seizure of uncertain cause. On the 92nd postoperative day, the patient had diarrhea and vomiting, leading to aspiration pneumonia and sepsis. Death occurred on the 112th day, preceded by progressive renal failure and refractory hypotension, despite maintenance of cardiac output. Autopsy revealed extensive pseudomembranous colitis, acute tubular necrosis, peritoneal and pleural effusion, centrilobular emphysema, and chronic bronchitis with fibrosis and bronchiectasis. The artificial heart system was intact and uninvolved by thrombosis or infectious processes. This experience should encourage further clinical trials with the artificial heart, but we emphasize that the procedure is still highly experimental. Further experience, development, and discussion will be required before more general application of the device can be recommended.
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PMID:Clinical use of the total artificial heart. 1476 80

Monitoring via a pulmonary artery catheter has been advocated for all patients undergoing abdominal aortic surgery. This study was performed to identify a subgroup of patients who could be safely monitored with a central venous catheter. One hundred twenty-eight consecutive patients undergoing elective infrarenal abdominal aortic surgery were prospectively evaluated for risk of developing perioperative myocardial dysfunction based on criteria determined by the history and physical examination, chest radiography, and electrocardiography. Forty-five patients were identified as having no clinical evidence of coronary artery disease. These patients were then monitored perioperatively using a central venous catheter. All patients monitored via a central venous catheter underwent surgery for abdominal aortic aneurysmal disease (66.7%) or aortoiliac disease (33.3%) without intraoperative complications. There were 15 postoperative complications in 12 (26.7%) patients, comprised mainly of pulmonary (7) and gastrointestinal (3) complications. The cardiac-related morbidity was 4.4 per cent and consisted of congestive heart failure (1) and renal failure (1). No perioperative myocardial infarctions were detected. One (2.2%) postoperative death secondary to aspiration pneumonia occurred. The results of this data suggest that there exists a subgroup of patients undergoing elective infrarenal abdominal aortic surgery that can be monitored safely via a central venous catheter in the perioperative period.
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PMID:Selective monitoring in abdominal aortic surgery. 836 60

Pulmonary manifestations contribute significantly to the morbidity and mortality of the idiopathic inflammatory myopathies, ranging from intrinsic lung disease to secondary complications that include aspiration pneumonia, opportunistic infection, congestive heart failure, and hypoventilation. Newer classification schemes for interstitial lung disease have permitted closer correlation between histologic subtype and clinical outcome, while diagnostic techniques such as bronchoalveolar lavage have begun to define the cellular elements responsible for immune-mediated pulmonary dysfunction. Investigators have identified several serum markers correlating with inflammatory disease activity in the lung that should enhance noninvasive monitoring of therapeutic responses to newer regimens involving agents such as cyclosporine and tacrolimus. Taken together, these advances have contributed to better understanding of the immunopathogenesis of myositis-associated interstitial lung disease that should ultimately translate into more effective treatment.
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PMID:Pulmonary complications of inflammatory myopathy. 1221 46

Aspiration pneumonia is a serious problem for the elderly institutionalized person, often requiring transfer to a hospital and a lengthy stay there. It is associated with a high mortality rate and is very costly to the health care system. The current study sought to determine the key predictors of aspiration pneumonia in a nursing home population with the hope that health care providers could identify those residents at highest risk and focus more efforts on prevention of this serious disease. A cross-sectional, retrospective analysis was done, using the Minimum Data Set (MDS) nursing home assessment data for three states (New York, Mississippi, Maine) from 1993 to 1994 (N = 102842). Nursing home residents were aged 65+. Standardized MDS summary scales and their component items were used, including: the Activities of Daily Living (ADL) scale, the cognitive performance scale (CPS), and the Resource Utilization Groups (RUGs). Results of these analyses showed the prevalence of pneumonia among this population was 3% (n = 3118). Results from the logistic regression models indicated 18 significant predictors of aspiration pneumonia. The strongest to weakest predictors of pneumonia were, respectively, suctioning use, COPD, CHF, presence of feeding tube, bedfast, high case mix index, delirium, weight loss, swallowing problems, urinary tract infections, mechanically altered diet, dependence for eating, bed mobility, locomotion, number of medications, and age, while both CVA and tracheotomy care were inversely predictive of pneumonia. The emergence of these significant predictors suggested a different pathogenesis of pneumonia in the elderly nursing home resident from the acute care patient or the outpatient. Nursing home residents have chronic medical conditions that gradually lead to "decompensation" in functional status, nutritional status, and pulmonary clearance. Dysphagia and aspiration are common complications of their medical conditions and may slowly worsen as their status deteriorates. Alternatively, a sudden adverse event may dramatically increase the amount aspirated or the ability to resist infection and lead to sudden decompensation. Clinical staff must identify residents with dysphagia and aspiration and work to prevent decline in functional status in all residents. They must be aware of the dangers of adverse events that lead to sudden inactivity or illness and increase the risk of aspiration pneumonia. Prevention of this disease whenever possible will reduce costs, improve health outcomes, and improve our quality of care.
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PMID:Predictors of aspiration pneumonia in nursing home residents. 1235 45

Long-term prognosis in dialysis is poor compared to that in healthy control persons. A worsening of the prognosis is noted especially for patients who at initiation of dialysis have congestive heart failure, ischemic heart disease, or left ventricular dysfunction or hypertrophy. This is the main reason that cardiovascular causes are the most common for morbidity in these patients. The weight obtained when normal urine output is present is the dry weight. With reduced ability to excrete the volume by the kidneys in end-stage renal disease (ESRD), the body will retain water and the patient will gain weight. This extra weight is due to volume overload. While volume overload may induce a rise in blood pressure, if the heart is in acceptable condition, a fast removal of fluid by ultrafiltration (UF) during dialysis may instead cause hypotension. Ultrafiltration failure in peritoneal dialysis (PD) patients may lead to successive water retention and overhydration with subsequent cardiac failure, while volume overload may occur over a few days in hemodialysis (HD) patients. Anemia or even too-high hematocrit may impair cardiac function further and worsen conditions caused by wrong dry weight. Thus, during long-term and sustained volume overload, left ventricular (LV) hypertrophy will occur in an eccentric manner. A sustained overload then may lead to cell death and LV dilatation and, eventually, systolic dysfunction. Once a severe left ventricular dilatation has developed, the blood pressure may decrease during volume overload. A worsened prognosis is seen if malnutrition and low albumin levels are present. Volume overload necessitates ultrafiltration to achieve dry weight. Thereby, volume contraction contributes to exaggerated stimulation of or response to activation of the RAS and alpha-adrenergic sympathetic systems. If ultrafiltration goes beyond these compensatory mechanisms, hypotension will occur and increase the risk for hypoperfusion of vital organs. Such episodes may cause cardiac morbidity, aspiration pneumonia, vascular access closure, or neurological complications (seizures, cerebral infarction), besides a more rapid lowering of residual renal function. Preventive measures are, first, finding the right dry weight; second, minimizing interdialytic weight gain; third, optimizing the target for hemoglobin (110-120 g/l); fourth, lowering dialysate calcium (1.25 mmol/l); and fifth, eventually using higher dialysate potassium if long dialyses are performed.
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PMID:Ultrafiltration and dry weight-what are the cardiovascular effects? 1266 7


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