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

Aspiration pneumonias occur more frequently than reported and, in many cases, the disease is not recognised. In hospitalised and institutionalised patients with predisposing diseases prompt diagnosis of this complication and correct preventive measures can drastically reduce the worsening of clinical conditions and the deaths due to aspiration pneumonia. Normal airway structure, effective defence mechanisms, and preventive measures are decisive in reducing aspiration episodes. An increased aspiration risk for food, fluids, medications, or secretions may lead to the development of pneumonia. Pneumonia is the most common respiratory complication in all stroke deaths and in mechanical ventilation patients. In addition, the increased incidence of aspiration pneumonia with aging may be a consequence of impairment of swallowing and the cough reflex. Dysphagia, compromised consciousness, invasive procedures, anaesthesia, insufficient oral care, sleep disorders, and vomiting are all risk factors. Aspiration pneumonia includes different characteristic syndromes based on the amount (massive, acute, chronic) and physical character of the aspirated material (acid, infected, lipoid), needing a different therapeutic approach. Chronic patients education and correct health care practices are the keys for preventing the events of aspiration. In patients at risk a clinical and instrumental assessment of dysphagia should be evaluated. Management includes the removal of etiologic factors (drugs, tubes, mobilisation, oral hygiene), supportive care, and in bacterial pneumonias a specific antibiotic therapy for community-acquired or nosocomial events.
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PMID:Aspiration pneumonia. Pathophysiological aspects, prevention and management. A review. 1721 95

Dysphagia occurs frequently after a stroke. It is a major problem as patients are at risk of malnutrition and aspiration pneumonia. We aimed to identify the risk factors for and outcome of dysphagia over the first one month after an acute ischaemic stroke. Patients with acute first-ever ischaemic stroke admitted to the medical ward of Hospital Universiti Kebangsaan Malaysia (HUKM) between July 2004 and December 2004 were prospectively examined. Observation was done using pre-defined criteria. Demographic data, risk factors, and type of stroke were recorded on admission. The assessment of dysphagia was made using standardized clinical methods. All patients were followed up for three months. One hundred and thirty four patients were recruited in the study. Fifty-five patients (41%) had dysphagia at presentation. This number was reduced to 29 (21.6%) patients at one month. Logistic regression analysis revealed that age of more than 75 years [OR 5.20 (95% CI 1.89 - 14.30)], diabetes mellitus [OR 2.91 (95% CI 1.07 - 7.91)] and MCA infarct [OR 2.48 (95% CI 1.01-6.14)] independently predicts the occurrence of dysphagia after an acute stroke. Dysphagia at presentation was found to be an independent predictor of mortality at one-month [OR 5.28 (95% CI 1.51-18.45)] post ischaemic infarct. Dysphagia occurred commonly in ischaemic stroke. Advance age, diabetes mellitus and large infarcts were independently associated with the presence of dysphagia. Early stroke mortality can be independently predicted by the presence of dysphagia.
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PMID:Risk factors and outcome of dysphagia after an acute ischaemic stroke. 1762 55

Angiotensin converting enzyme (ACE) inhibitor plays an important role not only as an antihypertensive drug but also for prevention of various complications related to geriatric syndrome. Pneumonia in the disabled elderly is mostly due to silent aspiration of oropharyngeal bacterial pathogens to the lower respiratory tract. Aspiration is related to the dysfunction of dopaminergic neurons by cerebrovascular disease, resulting in impairments in both the swallowing and cough reflexes. ACE inhibitor can increase in the sensitivity of the cough reflex particularly in older post-menopausal women, and improvement of the swallowing reflex. In a 2-year follow-up study in stroke patients, patients who did not receive ACE inhibitors had a higher risk of mortality due to pneumonia than in stroke patients who were treated with ACE inhibitor. Moreover, the mortality of pneumonia was significantly lower in older hypertensive patients given ACE inhibitors than in those treated with other antihypertensive drugs. On the other hand, we found a new benefit of ACE inhibitor on the central nervous system. The mortality in Alzheimer's disease patients who received brain-penetrating ACE inhibitor was lower than in those who received other antihypertensive drugs. In a 1-year follow-up study, cognitive decline was lower in patients receiving brain-penetrating ACE inhibitors than in patients receiving a non-brain-penetrating ACE inhibitor or a calcium channel blocker. Brain-penetrating ACE inhibitors may slow cognitive decline in patients with mild to moderate Alzheimer's disease. ACE inhibitor might be effective for the disabled elderly, resulting in the prevention of aspiration pneumonia and Alzheimer's disease for the elderly.
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PMID:[The benefit of angiotensin converting enzyme inhibitor for geriatric syndrome in the elderly]. 1782

Neurogenic dysphagia occurs in many diseases, the most frequent cause being stroke. Diagnostic approaches include neurologic examination and fiberoptic and videofluoroscopic evaluations of swallowing, which are complementary. The pivotal aim of therapeutic interventions is the prevention of aspiration and aspiration pneumonia. Proof of the effectivity of some restitutional, compensatory, and adaptive methods is given.
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PMID:[Neurogenic Dysphagia]. 1797 43

The aim of this study was to investigate the changes in arterial oxygen saturation (SaO(2)) of stroke patients during mealtime and whether duration of feeding (time to finish a meal) and mode of feeding (self-feed versus being fed) were associated with such changes. This study also investigated whether the consequence of aspiration pneumonia in the stroke patients was associated with SaO(2) drops during mealtime. The findings of this study showed that stroke patients but not the controls had a small but significant SaO(2) drop during meals (0.91%, IQR = 1.53%, p < 0.05 in being fed; 1.04%, IQR = 1.35%, p = 0.013, in self-feed). Duration of feeding and mode of feeding, however, did not have an association with mealtime SaO(2) changes. The SaO(2) drop during mealtime was not an early indicator of aspiration pneumonia.
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PMID:Changes in arterial oxygen saturation (SaO(2)) before, during, and after meals in stroke patients in a rehabilitation setting. 1862 95

Effective swallowing is an essential part of life and is performed thousands of times per day, often without conscious consideration. Difficulty in swallowing (dysphagia) commonly arises in stroke patients following ischemia of the cerebral cortex. However, whereas this tends to resolve spontaneously in the majority of patients, a small percentage will be left with a persistent dysphagia, which predisposes to airway compromise and aspiration pneumonia. This article reviews the recent research into ways of restoring swallowing function in these patients through promoting plasticity and reorganisation of the remaining, viable cerebral cortex.
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PMID:Role of cerebral cortex plasticity in the recovery of swallowing function following dysphagic stroke. 1871 38

Swallowing disorders (or dysphagia) are common in the elderly and their prevalence is often underestimated. They may result in serious complications including dehydration, malnutrition, airway obstruction, aspiration pneumonia (infectious process) or pneumonitis (chemical injury caused by the inhalation of sterile gastric contents). Moreover the repercussions of dysphagia are not only physical but also emotional and social, leading to depression, altered quality of life, and social isolation. While some changes in swallowing may be a natural result of aging, dysphagia in the elderly is mainly due to central nervous system diseases such as stroke, parkinsonism, dementia, medications, local oral and oesophageal factors. To be effective, management requires a multidisciplinary team approach and a careful assessment of the patient's oropharyngeal anatomy and physiology, medical and nutritional status, cognition, language and behaviour. Clinical evaluation can be completed by a videofluoroscopic study which enables observation of bolus movement and movements of the oral cavity, pharynx and larynx throughout the swallow. The treatment depends on the underlying cause, extent of dysphagia and prognosis. Various categories of treatment are available, including compensatory strategies (postural changes and dietary modification), direct or indirect therapy techniques (swallow manoeuvres, medication and surgical procedures).
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PMID:[Swallowing disorders, pneumonia and respiratory tract infectious disease in the elderly]. 1962 4

Pneumonia is a significant complication of ischemic stroke that increases mortality. Post-stroke pneumonia is defined as newly developed pneumonia following stroke onset. Clinically and chronologically, post-stroke pneumonia is divided into two types of aspiration pneumonia. First, acute-onset post-stroke pneumonia occurs within 1 month after stroke. Second, insidious or chronic-onset post-stroke pneumonia occurs 1 month after the stroke. The mechanisms of pneumonia are apparent aspiration and dysphagia-associated microaspiration. Stroke and the post-stroke state are the most significant risk factors for aspiration pneumonia. The preventive and therapeutic strategies have been developed thoroughly and appropriate antibiotic use, and both pharmacological and nonpharmacological approaches for the treatment of post-stroke pneumonia have been studied rigorously. Increases in substance P levels, oral care, and swallowing rehabilitation are necessary to improve swallowing function in post-stroke patients, resulting in a reduction in the incidence of post-stroke pneumonia in a chronic stage. The stroke must be a cause of aspiration pneumonia.
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PMID:Novel preventive and therapuetic strategy for post-stroke pneumonia. 1967 7

With the increase in the elderly population, the prevalence of systemic diseases such as strokes and heart attacks will also increase. Persons who have had a stroke will be more susceptible to mistreatment, neglect, abuse, and aspiration pneumonia. The expansion of the elderly population will make the training of professional healthcare workers and other auxiliaries extremely important. Quality of life can be maintained if poor oral health is reduced through better daily oral hygiene practices. Informing others about the known association between oral health and systemic diseases will increase the awareness of the need for good oral hygiene in order to reduce the risk of systemic diseases. Healthcare professionals must also be able to recognize, document, and report to Adult Protective Services suspected abuse such as physical and dental neglect. The networking of healthcare providers with Adult Protective Services and other professional disciplines will provide a collaborative approach to assure successful integration of healthcare protocols for the elderly population.
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PMID:Improving oral healthcare: improving the quality of life for patients after a stroke. 1974 Jan 54

Pneumonia and primary lung abscesses may result from aspiration of infectious material from the oropharyngeal cavity and the upper respiratory tract. Most subjects suffer from an impaired mechanical or immunologic defense, for example alcoholism or dysphagia following stroke. The early course of the disease is uncharacteristic. Necrotizing pneumonia, pulmonary abscesses and the characteristic, foul-smelling, putrid discharge only occur 8-14 days after the initial aspiration event. Although common respiratory pathogens are frequently isolated from the lower airways of these patients, anaerobic bacteria play a pivotal role in cavitary lung disease following aspiration. Anaerobic coverage is therefore a requirement for an adequate antibiotic regimen, and antibacterial activity against common respiratory pathogens appears reasonable in most cases. Aminopenicillins/beta-lactamase inhibitors, newer fluoroquinolones with anaerobic activity (moxifloxacin) and clindamycin have demonstrated equal clinical efficacy in the treatment of aspiration pneumonia and primary lung abscess. Prolonged antibiotic therapy is required in cases with extensive damage of lung tissue. Since antibiotics can provide cure in 80-90% of cases, surgical procedures are limited to severe complications, such as pleural empyema. Cavitary lung disease has a broad differential diagnosis, including aspiration of sterile gastric content (Mendelson syndrome), staphylococcal pneumonia, tuberculosis, primary carcinoma of the lung, metastases and vasculitis.
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PMID:Aspiration pneumonia and primary lung abscess: diagnosis and therapy of an aerobic or an anaerobic infection? 2047 71


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