Seminars in respiratory and critical care medicine
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Semin Respir Crit Care Med · Dec 2024
Review"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. ⋯ 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.
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Semin Respir Crit Care Med · Dec 2024
ReviewBacteriology of Aspiration Pneumonia: The Lung Microbiome and the Changing Microbial Etiology.
Aspiration pneumonia refers to the process of alveolar inflammation induced by the inhalation of oropharyngeal secretions into the lower respiratory tract. Predisposing factors comprise swallowing dysfunction, impaired cough reflex, and degenerative neurological diseases. Accumulating evidence projects a fading contribution of anaerobic bacteria in aspiration pneumonia at the expense of Gram-negative bacilli, with Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa, becoming the predominant organisms recovered from respiratory specimens. ⋯ Understanding this complex temporal variability between microbiome-host associations was only made possible with the introduction of metagenomic sequencing. In this narrative review, we summarize existing knowledge and elaborate on the evolving microbiology of aspiration pneumonia including the link between oral microbiome and pulmonary aspiration. We also highlight the progress and challenges in instituting microbiome-targeted strategies for preventing and treating the sequelae of aspiration pneumonia.
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Semin Respir Crit Care Med · Dec 2024
ReviewPrevention of Aspiration: Oral Care, Antibiotics, Others.
Patients with aspiration pneumonia often develop this lung infection due to poor oral health or because the contents of the digestive tract or upper airway enter the lower airway traversing the larynx through different mechanisms. Prevention of this condition is directed at the mechanism by which it occurs. ⋯ People with dysphagia complicated by pneumonia have limited feeding and become debilitated, and aspiration pneumonia in these individuals has a high mortality rate at 90 days. Dietary modifications, assistance with feeding, use of postures that facilitate a normal deglutition, rehabilitation, and use of medications to improve swallowing defects are the tools of medicine to overcome the obstacles to swallowing normally and prevent the development of aspiration pneumonia and its consequences.
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Semin Respir Crit Care Med · Dec 2024
ReviewMedications to Modify Aspiration Risk: Those That Add to Risk and Those That May Reduce Risk.
Aspiration pneumonia results from the abnormal entry of fluids into the respiratory tract. We present a review of drugs known to affect the risk of aspiration. Drugs that increase the risk of aspiration pneumonia can be broadly divided into those that affect protective reflexes (like cough and swallowing) due to direct or indirect mechanisms, and drugs that facilitate gastric dysbiosis or affect esophageal and intestinal motility. ⋯ Focusing on modifiable risk factors for aspiration pneumonia is relevant since this may help to reduce the incidence of this often severe problem. Among these, several commonly used drug classes have been shown to increase the risk of aspiration pneumonia. These drugs should be withheld in the high-risk population whenever possible, alongside general measures, such as the semirecumbent position during sleep and feeding.
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Semin Respir Crit Care Med · Dec 2024
ReviewAspiration after Anesthesia: Chemical versus Bacterial, Differential Diagnosis, Management, and Prevention.
Aspiration following anesthesia is a major patient issue and a difficulty for anesthesiologists. Aspiration syndromes are more common than anticipated, and the condition is frequently undetected. Clinical signs are often dictated by the characteristics of aspiration, such as the infectivity of the material, its volume, and the severity of the underlying clinical condition. ⋯ In addition, drugs such as proton pump inhibitors can help lower stomach acidity and volume. Innovations in monitoring techniques, better training, and awareness activities are critical to enhancing aspiration event management. Given the importance of this entity, this narrative review sought to make an updated overview of the management of aspiration after anesthesia: chemical versus bacterial, differential diagnosis, management, and prevention.