ABSTRACT
Objective:To investigate the aspiration risk of preventive placement of nasal jejunum nutrition tube in advanced esophageal cancer patients receiving radiotherapy and the influencing factors.Methods:The clinical data of 220 patients with advanced esophageal cancer who received radiotherapy and preventive placement of nasal jejunum nutrition tube feeding from November 2020 to November 2021 in Cancer Hospital, Chinese Academy of Medical Sciences were retrospectively analyzed. The level of aspiration risk was measured according to the standard swallowing function assessment scale (SSA). The questionnaire collected the following data: (1) the general data including gender, age, educational level, history of smoking, history of alcoholism, knowledge of aspiration; (2) the disease factors including tumor staging, tumor site, swallowing function, abdominal distention; (3) the nosocomial factors including history of esophageal cancer surgery, sedation and analgesia treatment, combination of chemotherapy or not, cumulative radiotherapy dose, grade of radiation esophagitis, the position, time and tube feeding method of enteral nutrition. The standard swallowing function of patients was measured and repeated saliva swallowing test (RSST) was used to screen the patients with the difficulty in the esophageal function swallowing. Multiple linear regression was used to analyze the factors affecting aspiration risk.Results:A total of 220 patients with advanced esophageal cancer were enrolled in the investigation. Finally, 70 patients (31.8%) had grade 0 aspiration risk, and SSA score was 19; 23 patients (10.5%) had grade I aspiration risk, and SSA score was (23.4±1.3); 103 patients (46.8%) had grade Ⅱ aspiration risk, and SSA score was (27.5±1.1); 24 patients (10.9%) had grade Ⅲ aspiration risk, and SSA score was (33.2±1.5); 136 patients (61.8%) in total had aspiration risk. There were 32.7% (72/220) patients knowing the knowledge of aspiration. Multifactor analysis showed that esophageal tumor site ( t = -2.869, P = 0.005), cumulative radiotherapy dose ( t = 5.558, P < 0.001), grade of radiation esophagitis ( t = 11.405, P < 0.001), the duration time of enteral nutrition ( t = 4.050, P < 0.001) were independent factors affecting the aspiration risk. Conclusions:The aspiration risk of preventive placement of nasal jejunum nutrition tube in advanced esophageal cancer patients receiving radiotherapy is high, which is related to esophageal tumor site, grade of radiation esophagitis, cumulative radiotherapy dose and the duration time of enteral nutrition.
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Objective By now, there is no unified definition of aspiration pneumonia. However, patients with community-acquired pneumonia (CAP) often have aspiration risk factors. The aims of our study is to explore the clinical characteristics and outcomes of CAP patients with aspiration risk factors. Methods Cases data of all patients hospitalized with CAP in 5 teaching hospitals in Beijing, Shandong Province and Yunnan Province from January 1, 2013 to December 31, 2015 were collected. Data from patients with (AR-CAP) and without (non AR-CAP) aspiration risk factors were compared, including demographic features, clinical and radiologic findings and outcomes. A Cox proportional hazard model was used to determine the impact of aspiration risk factors on the 30-day mortality in CAP patients. Receiver operating characteristic curves (ROCs) was performed to verify the accuracy of CURB-65 score and PSI risk classification as 30-day mortality predictors in AR-CAP patients. Results Totally, 3561 CAP cases were entered into the final analysis. AR-CAP cases accounted for 5.1% (180/3561), who showed older age [78.0 yrs (M1,M3: 70.0 yrs, 85.0 yrs) vs 63.0 yrs (M1,M3: 52.0 yrs, 77.0 yrs), P < 0.001), more underlying diseases (91.1% vs 71.3%, P < 0.001), more frequently classified as CURB-65 score ≥ 3 (13.3% vs 1.5%, P < 0.001) and PSI risk classification ≥ Ⅳ (53.7% vs 17.0%，P< 0.001), and higher 30-day mortality (10.0% vs 1.8%, P < 0.001). Adjusted for age, sex, comorbidities and CURB-65/PSI score, aspiration risk factors were associated with increased 30-day mortality of CAP patients (HR 2.844, 95% CI 1.331~6.078, P = 0.007). The area under the ROC curve for predicting 30-day mortality in AR-CAP patients by PSI risk class was 0.716, which was higher than CURB-65 score (AUC=0.518, P = 0.019). The difference was statistically significant. Conclusion AR-CAP is a distinctive pneumonia phenotype with unique clinical characteristics, which shows more illness severity and worsen outcomes.
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BACKGROUND AND PURPOSE: The presence of dysphagia and aspiration in stroke patients is associated with increased mortality and morbidity. Early recognition and management of these two conditions via reliable, minimally invasive bedside procedures before complications arise remains challenging in everyday clinical practice. This study reviews the available bedside screening tools for detecting swallowing status and aspiration risk in acute stroke by qualitatively observing reference population study design, clinical flexibility, reliability and applicability to acute-care settings. METHODS: The primary search was conducted using the PubMed, Embase, and Cochrane Library databases. The search was limited to papers on humans written in English and published from 1991 to 2016. Eligibility criteria included the consecutive enrollment of acute-stroke inpatients and the development of a protocol for screening aspiration risk during oral feeding in this population. RESULTS: Of the 652 sources identified, 75 articles were reviewed in full however, only 12 fulfilled the selection criteria. Notable deficiencies in most of the bedside screening protocols included poor methodological designs and inadequate predictive values for aspiration risk which render clinicians to be more conservative in making dietary recommendations. CONCLUSIONS: The literature is dense with screening methods for assessing the presence of dysphagia but with low predictive value for aspiration risk after acute stroke. A standard, practical, and cost-effective screening tool that can be applied at the bedside and interpreted by a wide range of hospital personnel remains to be developed. This need is highlighted in settings where neither trained personnel in evaluating dysphagia nor clinical instrumentation procedures are available.