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

Following stroke, patients may have reduced dietary intake, swallowing impairments (dysphagia) and other neurological deficits that could affect their nutritional and hydration status and lead to aspiration pneumonia. Impaired nutritional status is associated with reduced functional improvement, increased complication rates and prolonged hospital stays. This article is aimed at primary care physicians and others caring for stroke patients. We discuss the need for assessing the nutritional status of stroke patients and provide strategies for the management of dysphagia and patients' food and fluid intakes. In addition, we review clinical and radiological options for the diagnosis of dysphagia as well as oral and enteral feeding alternatives.
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PMID:Rehabilitation medicine: 2. Diagnosis of dysphagia and its nutritional management for stroke patients. 1505 81

The third most common stroke complication is infection. We studied the rates of aspiration pneumonia and urinary tract infection (UTI), their risk factors and their effect on outcome in the 1455 Glycine Antagonist (Gavestinel) in Neuroprotection (GAIN) International patients with ischaemic stroke. Forward stepwise logistic regression and Cox proportional hazards modelling identified baseline factors that predicted events and the independent effect of events up to day 7 on poor stroke outcome at 3 months in patients alive at day 7, after correcting for prognostic factors. Higher baseline National Institute of Health Stroke Scale (NIHSS) and age, male gender, history of diabetes and stroke subtype predicted pneumonia, which occurred in 13.6% of patients. Female gender and higher baseline NIHSS and age predicted UTI, which occurred in 17.2% of patients. Pneumonia was associated with poor outcome by mortality (hazard ratio, 2.2; 95% confidence interval, 1.5-3.3), Barthel index (<60) (odds ratio, 3.8; 2.2-6.7), NIHSS (4.9; 1.7-14) and Rankin scale (>/=2) (3.4; 1.4-8.3). UTI was associated with Barthel index (1.9; 1.2-2.9), NIHSS (2.2; 1.2-4.0) and Rankin scale (3.1; 1.6-4.9). Pneumonia and UTI are independently associated with stroke poor outcome. Patients with identified risk factors must be closely monitored for infection.
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PMID:Pneumonia and urinary tract infection after acute ischaemic stroke: a tertiary analysis of the GAIN International trial. 1469 88

A 78-year-old man suffered from refractory aspiration pneumonia as a result of a minor medullary stroke. The only neurological symptom observed in this patient was difficulty in swallowing. He was managed with i.v. hyperalimentation with termination of oral intake, including water. However, he still experienced several episodes of aspiration pneumonia. As he was considered to have a bacterial infection because of silent aspiration of colonized oropharyngeal material, inhalation of tobramycin was introduced and successful control of airway infection was attained.
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PMID:Inhalation of tobramycin in a patient with aspiration pneumonia as a result of medullary stroke. 1561 72

Recent clinical studies have emphasized the up-regulation (sensitization) of cough in pathological conditions of the airways. However there are also many situations where voluntary and reflex cough can be down-regulated. These include: (1) chemical stimulation of breathing by hypercapnia or hypoxia or both, establishing that cough sensitivity can be inversely related to drive to breathing; (2) voluntary inhibition of cough, probably similar in mechanism to the depression of cough that can be induced by hypnosis and other branches of alternative medicine; (3) the placebo effect of many antitussive treatments; (4) sleep; (5) general anaesthesia; (6) central nervous disorders such as coma, stroke, Parkinson's disease and several other conditions where the defect in the protective reflexes may lead to aspiration pneumonia; (7) increased activity in various afferent inputs from viscera in the thorax and abdomen; (8) a number of bronchopulmonary clinical disorders. The list is long, but regrettably the nervous mechanisms of these down-regulations have been little studied. In addition there are a number of situations, such as exercise, coitus, talking and singing which, while important to coughing humans, have been not investigated in relation to cough. Most of the studies have been with experimental animals, and their extension to human research is desirable. In view of the importance of cough and other defensive reflexes in maintaining human well-being, far more research is needed. The field is wide-open.
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PMID:Physiological and pathophysiological down-regulation of cough. 1587 97

Myasthenia gravis (MG) classically presents with ocular, bulbar, and predominantly proximal muscle weakness. Isolated bulbar symptoms occur in less than 25% of cases and can mimic stroke (1-3). If left untreated, MG can lead to significant morbidity and mortality, including myasthenic crisis and recurrent aspiration pneumonia. We describe a case of a 68-year-old man who presented with isolated bulbar symptoms. We used a novel approach to diagnosis which included a videofluorographic swallow study with concomitant Tensilon (edrophonium) injection.
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PMID:Clinical utility of videofluorography with concomitant Tensilon administration in the diagnosis of bulbar myasthenia gravis. 1590 57

An intrapulmonary percussive ventilator (IPV) improves airway clearance and lung function, and is useful for wide variety of respiratory disorders, such as cystic fibrosis, chronic obstructive pulmonary disease, aspiration pneumonia, and neuromuscular diseases. However, there are few reports on IPV use in patients with severe neurological impairment, scoliosis and thoracic deformity. They have poor mobility of the rib cage and difficulty in sputum expectoration. The use of IPV significantly improved persistent consolidation shown by chest computed tomography (CT) in one of such patients. The patient was a 33-year-old woman with severe spastic quadriplegia and tracheostomy and she was dependent on mechanical ventilation because of chronic restrictive respiratory failure. After fever and mild hypoxemia for one day, chest CT revealed consolidation of the left lower lobe. An IPV-I ventilator was used for 15 min once a week, with a stroke frequency of 250-300 cycles/min and pressure of 22 PSI. Mechanical ventilation was withheld during the IPV therapy. Chest physiotherapy was also done. According to the worsening of the consolidation on chest CT, the frequency of IPV was changed to once a day at day 23 and then to twice a day. Chest CT at day 44 showed further improvement. In patients with severe motor and intellectual disabilities, it is sometimes difficult to control progressive deterioration of pulmonary function and persistent atelectasis even with tracheostomy, mechanical ventilation, and conventional physiotherapy. Our results indicate that IPV may improve respiratory functio and the quality of life in such patients.
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PMID:[Effect of intrapulmonary percussive ventilation in a severely disabled patient with persistent pulmonary consolidation]. 1602

Swallowing musculature is asymmetrically represented in both motor cortices. Stroke affecting the hemisphere with the dominant swallowing projection results in dysphagia and clinical recovery has been correlated with compensatory changes in the previously non-dominant, unaffected hemisphere. This asymmetric bilaterality may explain why up to half of stroke patients are dysphagic and why many will regain a safe swallow over a comparatively short period. Despite this propensity for recovery, dysphagia carries a sevenfold increased risk of aspiration pneumonia and is an independent predictor of mortality. The identification, clinical course, pathophysiology, and treatment of dysphagia after stroke are discussed in this review.
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PMID:Dysphagia in stroke patients. 1675 7

Dysphagia (swallowing difficulties) is relatively common in the general population, but the prevalence increases with age and poses particular problems in the older patient, potentially compromising nutritional status, complicating the administration of solid medications, increasing the risk of aspiration pneumonia and undermining the quality of life. The repercussions of dysphagia are not only physical but also emotional, affecting patient morale and leading to feelings of social isolation. There are various causes, including carcinoma, stroke and advanced Alzheimer's disease. The diverse range of causes may manifest in a number of different ways, but should always act as a warning sign, which requires further investigation. Management is multidisciplinary, depending on the underlying cause, extent of dysphagia and likely prognosis. This article examines the incidence, causes and management of dysphagia, based on a review of recent literature. The focus is on the nurse's role in the management of this challenging disorder with particular emphasis on the care of the elderly patient.
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PMID:Dysphagia in the elderly--a management challenge for nurses. 1683 52

This study investigated the frequency of aspiration pneumonia in conscious stroke patients fed by a family member and examined the effect of introducing training in swallowing techniques by nurses. A total of 96 consecutive patients presenting with dysphagia due to acute stroke were included in the study. Patients presenting between January 2000 and July 2003 (n = 48) were fed orally by a family member given general nursing information (group A), whereas those presenting between August 2003 and March 2005 (n = 48) were fed orally by an experienced nurse trained in specific swallowing techniques (group B). All patients were examined daily for the presence of aspiration pneumonia. The incidence of aspiration pneumonia was 33.3% in group A and 6.3% in group B (P < 0.05). The incidence of aspiration pneumonia in dysphagic stroke patients who are orally fed is still high. Training in swallowing during oral feeding offers clear protection against pneumonia in conscious stroke patients.
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PMID:Training in swallowing prevents aspiration pneumonia in stroke patients with dysphagia. 1686 25

Elevated plasma homocysteine levels are associated with an increased risk of developing atherosclerotic vascular disorders such as stroke, but have also been implicated for neurodegenerative diseases including Alzheimer's disease (AD). Other studies have reported that hyperhomocysteinemia is associated with developing silent brain infarctions and white matter lesions in community-dwelling elderly people. It is not uncommon for such ischemic cerebrovascular lesions to be found in otherwise typical AD patients on magnetic resonance imaging. Such co-existing cerebrovascular diseases in AD must be important in developing aspiration pneumonia and falls. Previous studies demonstrated that basal ganglia infarcts, either silent or symptomatic, impaired swallowing function and these lesions were associated with an increased risk of developing aspiration pneumonia in AD patients, particularly in later stages. Further, periventricular white matter lesions are associated with an increased risk of falls irrespective of clinical stages of AD.
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PMID:[Importance of vascular aspects in Alzheimer's disease]. 1693 30


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