Neumonía secundaria a aspiración silenciosa en pacientes con trastorno de deglución mayores de 30 años, en el Hospital Universitario San Ignacio / Pneumonia due to silent aspiration in patients with swallowing disorders over thirty years old at the San Ignacio University Hospital

Identificar pacientes en riesgo de cursar con neumonía aspirativa secundaria a trastornos de deglución y omorbilidades asociadas. Difundir la utilidad del estudio funcional dinámico de deglución (FEES, por sus siglas en inglés) para la evaluación de estos pacientes. Diseño: Observacional descriptivo. Materiales y métodos: Revisión de historias clínicas de 2005 a 2008 del Hospital San. Ignacio con diagnóstico de: neumonitis debida a aspiración de alimento y disfagia. Resultados: En nuestro hospital el 90,5 por ciento de los pacientes con posibles trastornos de deglución no son estudiados. Conclusiones e importancia clínica: Se debe implementar para pacientes con factores de riesgo elestudio funcional dinámico de la deglución si se sospecha aspiración silenciosa. Como veremos más adelante, el estudio funcional dinámico de la deglución representa una alternativa válida, ofrece ventajas con respecto a la cinedeglución y debe ser considerado como un complemento al estudio radiológico de los pacientes con trastornos de la deglución. Estudiar mejor estos pacientes permitirá desarrollar estrategias para disminuir episodios de aspiración y por consecuencia eventos de neumonía.

Objective: To identify patients in risk of dealing with aspirative pneumonia secondary to swallowing disorders and associated conditions. Spread the utility of the Functional Endoscopic Evaluation of Swallowing (FEES) for the evaluation of these patients. Design: Descriptive observational study. Materials and methods: Review of medical charts from 2005 to 2008 with diagnosis of: pneumonitis due to food aspiration and dysphagia at the San Ignacio Hospital. Results: At the hospital, 90,5 percent ofthe patients with possible swallowing disorders is not studied. Conclusions and clinical importance: The FEES must be implemented for patients with risk factors if silent aspiration is suspected. For us, the functional endoscopic evaluation of swallowing offers advantages in regard to ideofluoroscopy, and should be considered as a complimentary test in patients with swallowing disorders. Better evaluation of these patients will led us to develop in the future new strategies to diminish episodes of aspiration and events of pneumonia.

Radiographic and computed tomographic evaluation of experimentally induced lung aspiration sites in dogs

This study was performed to radiographically examine the prevalence of aspiration sites and to evaluate their atomical correlation with the bronchial pattens. Ten healthy beagle dogs were repeatedly radiographed, at weekly intervals, in the left and right lateral, ventrodorsal (VD) and dorsoventral (DV) positions. Three mililiters of iohexol distilled with same volume of saline was infused into the tracheal inlet. Which lung lobe was aspirated was decided upon by the presence of a significant alveolar pattern due to the contrast medium. Alveolar patterns were identified at the left (100%) and right cranial lung lobes (77%) with the dogs in dependant lateral recumbency, at the right caudal lung lobe (71%) with the dogs in VD recumbency and at the right middle lung lobe (59%) with the dogs in DV recumbency, respectively. The anatomical correlation was evaluated by performing computed tomography. The right principal bronchus (165.8 +/- 1.6 degrees) was more straightly bifurcated than was the left principal bronchus (142.7 +/- 1.8 degrees, p < 0.01). In VD position, the right side lung had a greater opertunity to become aspirated. The ventrally positioned right middle lobar bronchial origin was more easily to be aspirated the other laterally positioned ones. We think that these anatomical characteristics can be one of the causes for aspiration pneumonia to occur more frequently in the right side lung.