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1.
J. Health NPEPS ; 6(2): 1-17, dez. 2021.
Article in English | ColecionaSUS, LILACS, BDENF, ColecionaSUS | ID: biblio-1349299

ABSTRACT

ABSTRACT Objective: adapt and validate the Barnes-Jewish Hospital-Stroke Dysphagia Screen (BJH-SDS) instrument to European Portuguese speakers. Method:BJH-SDS underwent a rigorous process of cross-cultural adaptation and was validated with acute stroke patients in five stroke units from February 2018 to April 2019. For data analysis, SPSS 25 was used. Nurses performed the screening on admission, and inter-rater reliability was established. Results of clinical bedside evaluation were compared with those provided by BJH-SDS. Results: cross-cultural adaptation was performed and completed successfully without difficulties. For validation, 226 acute stroke patients were enrolled. The incidence of dysphagia using BJH-SDS was 72.1%, and a highly significant relationship (χ2 = 87.81; p <0.001) was observed compared to clinical bedside evaluation, with an area under the ROC curve of 0,765. Excellent inter-rater reliability (k=0.977) was reached.Conclusion: results suggest that the Portuguese version of the BJH-SDS is a reliable dysphagia screening test. It is straightforward to be administered bedside by nurses with minimal training required. It was also shown to have adequate sensitivity to assist in decision-making to refer stroke patients for a more comprehensive evaluation.


RESUMEN Objetivo: adaptar y validar el Barnes-Jewish Hospital-Stroke Dysphagia Screen (BJH-SDS) para portugués de Portugal. Método: se realizó un riguroso proceso de adaptación transcultural y validación con pacientes con accidente cerebrovascular agudo en cinco hospitales entre febrero de 2018 y abril de 2019. El análisis de datos se realizó con SPSS 25. El cribado fue realizado por enfermeras. Los resultados de la evaluación clínica a pie de cama se compararon con los de BJH-SDS. Resultados: se realizó la adaptación transcultural y completado con éxito sin dificultades. Para la validación, se incluyeron 226 pacientes. La incidencia de disfagia por BJH-SDS fue del 72,1% y se observó una relación muy significativa con la evaluación clínica a pie de cama (χ2 = 81,87; p <0,001), un área bajo la curva ROC de 0,765. La fiabilidad entreexaminadores fue excelente (k = 0,977). Conclusión: los resultados sugieren que la versión portuguesa de la BJH-SDS es una prueba de detección fiable para la disfagia. Es fácil y simple de usar junto a la cama por parte de enfermeras con una formación mínima requerida. Mostró una sensibilidad adecuada para ayudar en la toma de decisiones para derivar a estos pacientes para una evaluación más completa.


RESUMO Objetivo:adaptar e validar o Barnes-Jewish Hospital-Stroke Dysphagia Screen (BJH-SDS) para o português de Portugal. Método:realizado um rigoroso processo de adaptação transcultural e validação com pacientes com acidente vascular cerebral agudo em cinco hospitais entre fevereiro de 2018 e abril de 2019. A análise dos dados foi realizada com SPSS 25. O rastreio foi realizado por enfermeiras na admissão. Os resultados da avaliação clínica à beira do leito foram comparados com os fornecidos pelo BJH-SDS. Resultados:a adaptação transcultural foi realizada e completada com sucesso sem dificuldades. Para validação, 226 pacientes foram incluídos. A incidência de disfagia pelo BJH-SDS foi de 72,1% e uma relação altamente significativa foi observada quando comparada aos resultados da avaliação clínica à beira do leito (χ2 = 81,87; p <0,001), com uma área abaixo da curva ROC de 0,765. A confiabilidade inter examinador alcançada foi excelente (k = 0,977). Conclusão:os resultados sugerem que a versão portuguesa do BJH-SDS é um teste de rastreio da disfagia confiável. É de utilização fácil e simples à beira do leito por enfermeiras com mínimo de treinamento necessário. Demonstrou ter sensibilidade adequada para auxiliar na tomada de decisão de encaminhar estes pacientes para uma avaliação mais abrangente


Subject(s)
Pneumonia, Aspiration , Deglutition Disorders , Reproducibility of Results , Stroke
2.
Int. j. odontostomatol. (Print) ; 14(4): 508-512, dic. 2020.
Article in Spanish | LILACS | ID: biblio-1134528

ABSTRACT

RESUMEN: ¿Por qué es importante la salud oral en la prevención de enfermedades respiratorias en tiempos de pandemia? La razón es simple, cualquier enfermedad respiratoria en la persona mayor, podría eventualmente activar alarma de COVID-19 positivo, pudiendo ser esta ocasionada por otro motivo, sin mencionar el riesgo aumentado de tener una enfermedad previa de tipo respiratoria en tiempos de pandemia, sobre todo, en una población de riesgo como las personas mayores institucionalizadas. Por esta razón, la prevención en higiene oral de personas mayores mediante un Protocolo que proponga lineamientos a seguir en Establecimientos de Larga Estadía para Adultos Mayores, es fundamental en la prevención de Neumonía por aspiración. Cabe mencionar, que desde antes de surgir el COVID-19, ya la Neumonía se considera la principal causa de muerte por enfermedades infecciosas en la población chilena, y la primera causa específica de muerte en los mayores de 80 años.


ABSTRACT: Why is oral health important in the prevention of respiratory diseases in times of pandemic? The reason is simple, any respiratory disease in the elderly could eventually trigger a positive COVID-19 alarm, and this could be caused by another reason, not to mention the increased risk of having a previous respiratory-type illness in times of pandemic, over everything, in a population of risk like the institutionalized older people. For this reason, the prevention of oral hygiene in older people through a Protocol that proposes guidelines to be followed in long-stay establishments for older adults, is essential in the prevention of aspiration Pneumonia. It is worth mentioning that, before the emergence of COVID-19, Pneumonia was considered the main cause of death from infectious diseases in the Chilean population and the first specific cause of death in those over 80 years of age.


Subject(s)
Humans , Aged, 80 and over , Oral Hygiene/methods , Pneumonia, Aspiration/prevention & control , Coronavirus Infections/epidemiology , Chile/epidemiology , Clinical Protocols , Oral Health/statistics & numerical data , Long-Term Care , Pandemics/prevention & control , Hospitalization/statistics & numerical data
3.
Article in Korean | WPRIM | ID: wpr-811299

ABSTRACT

Many hospitals have patients perform preparative fasting prior to contrast-enhanced computed tomography to prevent nausea, vomiting, and accompanying aspiration pneumonia. This policy has been regarded as reasonable because there are many side effects such as vomiting when ionic high-osmolar contrast media are used. Recent advancements in contrast media development, side effects such as nausea and vomiting have markedly decreased. However, fasting prior to the contrast-enhanced computed tomography examination is still customary. While debatable, it is not clear that fasting prior to the use of contrast media has a beneficial effect on the prevention of vomiting. On the contrary, excessive fasting can cause patient dissatisfaction, dehydration, and exhaustion. Therefore, before using contrast media, the duration of fasting should be determined based on consideration of the risks, benefits, and patient’s comfort. In particular, to prevent dehydration, limitation of liquid intake during fasting is not recommended.


Subject(s)
Contrast Media , Dehydration , Fasting , Humans , Nausea , Pneumonia, Aspiration , Vomiting
4.
Rev. pediatr. electrón ; 16(2): 15-17, ago. 2019.
Article in Spanish | LILACS | ID: biblio-1021339

ABSTRACT

OBJETIVOS: Presentar brevemente las principales patologías pulmonares y sus interferencias en la alimentación de niños. MÉTODOS: Se trata de una Actualización, basada en referencias bibliográficas actuales y referencias en pediatría. RESULTADOS: Se presentaron las posibles alteraciones de deglución en niños con: Bronquilitis Viral Aguda, Displasia Broncopulmonar, Enfermedades Intersticiales Pulmonares y Neumonias Aspirativas. CONCLUSIONES: Este material sirve para dirigir la atención del público de atención en salud en general, para trastornos de deglución niños neumópatas.


OBJECTIVES: Present briefly the main pulmonary pathologies and their interferences in the feeding of children. METHODS: This is an Update, based on current bibliographical references and references in pediatrics. RESULTS: Possible alterations of swallowing were presented in children with: Acute Viral Bronchitis, Bronchopulmonary Dysplasia, Pulmonary Interstitial Diseases and Aspirative Pneumonia. CONCLUSIONS: This material serves to direct the attention of the health care public in general, for children swallowing disorders pneumatics.


Subject(s)
Humans , Child , Deglutition Disorders/etiology , Lung Diseases/complications , Pneumonia, Aspiration/complications , Bronchopulmonary Dysplasia/complications , Bronchiolitis, Viral/complications , Lung Diseases, Interstitial/complications
5.
Distúrb. comun ; 31(2): 255-260, jun. 2019. tab
Article in Portuguese | LILACS | ID: biblio-1008159

ABSTRACT

Introdução: Penetração e/ou aspiração laringotraqueal (PA) são achados clínicos que constituem importante parâmetro na mensuração do risco para a segurança da deglutição devido às possíveis complicações pulmonares. Objetivo: Identificar a prevalência de penetração e/ou aspiração na Doença de Parkinson (DP) em Centro Especializado de Reabilitação (CER). Método: Estudo clínico observacional retrospectivo. Foram analisados 39 laudos de exames de videoendoscopia da deglutição realizadas em Centro Especializado de Reabilitação "Universidade Estadual Paulista-UNESP/Marília", no período de 2006 a 2016. Dos 39 (100%) indivíduos, 19 (48,71%) eram do gênero feminino e 20 (51,28%) do gênero masculino, com idade que variou de 43 a 85 anos (média de idade de 71 anos) e somente 29 (74,35%) desses indivíduos apresentavam classificação de Hoehn & Yahr (1967) variando de um a cinco. Realizada análise da PA nas consistências pastosa, líquida espessada e líquida e com volume que variou de 5 a 10 ml segundo a definição proposta por Rosenbek et al, 1996. Para análise estatística foi utilizado o Teste de Fisher. Resultados: Constatou-se que 28 (71,79%) indivíduos não apresentaram penetração e/ou aspiração laringotraqueal e 11 (28,21%) apresentaram. Desses 11 (28,21%), quatro (10,25%) apresentaram penetração/aspiração na consistência pastosa (p=0,05), nove (23,07%) no líquido espessado (p=0,07) e nove (23,07%) no líquido ralo (p=0,02). Conclusão: Na população estudada nesse setting a ausência de PA foi mais frequente e a presença significante apenas no líquido ralo.


Introduction: Laryngotracheal penetration and/or aspiration are clinical findings that are an important parameter in the measurement of the risk for swallowing safety due to possible pulmonary complications. Objective: To identify the prevalence of penetration and/or aspiration in Parkinson's disease (PD) in a Specialized Rehabilitation Center. Method: Retrospective observational clinical study. We analyzed 39 reports of fiberoptic endoscopy swallowing test performed at the Dysphagia Rehabilitation Center "University of São Paulo-UNESP/Marília" from 2006 to 2016. Of the 39 (100%) individuals, 19 (48.71%) were female and 20 (51.28%), ranging from 43 to 85 years old (mean age of 71 years), and only 29 (74.35%) of these individuals presented a classification of Hoehn & Yahr (1967) ranging from one to five. The analysis of the penetration and aspiration was performed in paste, liquid, thickened and liquid consistencies, with a volume varying from 5 to 10 ml according to the definition proposed by Rosenbek et al., 1996. For the statistical analysis Fisher's test was used. Results: It was verified that 28 (71.79%) individuals presented no laryngotracheal penetration and/or aspiration and 11 (28.21%) presented. Of these 11 (28.21%), four (10.25%) presented penetration / aspiration in paste consistency (p = 0.05), nine (23.07%) in the thickened liquid (p = 0.07) and nine (23.07%) in the thin liquid (p = 0.02). Conclusion: In the population studied in this setting, the absence of penetration and/or aspiration was more frequent and the presence was significant only of the liquid.


Introducción: Penetración y/o aspiración laringotraqueal (PA) son hallazgos clínicos que constituyen un importante parámetro en la medición del riesgo para la seguridad de la deglución debido a las posibles complicaciones pulmonares. Objetivo: Identificar la prevalencia de penetración y / o aspiración en la Enfermedad de Parkinson (DP) en Centro Especializado de Rehabilitación (CER). Método: Estudio clínico observacional retrospectivo. Se analizaron 39 casos de exámenes de videoendoscopia de la deglución realizados en Centro Especializado de Rehabilitación "Universidade Estadual Paulista-UNESP/Marília", del período de 2006 a 2016. De los 39 (100%) individuos, 19 (48,71%) eran del género femenino y 20 (51,28%) del género masculino, con edad que varía de 43 a 85 años (mediana de edad de 71 años) y solamente 29 (74,35%) de estos individuos presentaban clasificación de Hoehn & Yahr (1967) variando de uno a cinco años. Se realizó un análisis de la PA en las consistencias pastosa, líquida espesa y líquida y con volumen que varía de 5 a 10 ml según la definición propuesta por Rosenbek et al, 1996. Para el análisis estadístico se utilizó el test de Fisher. Resultados: Se constató que 28 (71,79%) individuos no presentaron penetración y / o aspiración laringotraqueal y 11 (28,21%) presentaron. En la mayoría de los casos, se observó una disminución de la producción de leche en la leche materna, (23,07%) en el líquido ralo (p = 0,02). Conclusión: En la población estudiada en ese ajuste la ausencia de PA fue más frecuente y la presencia significante sólo en el líquido.


Subject(s)
Adult , Middle Aged , Aged , Aged, 80 and over , Parkinson Disease , Pneumonia, Aspiration , Deglutition Disorders , Prevalence , Deglutition
6.
Clinical Endoscopy ; : 252-257, 2019.
Article in English | WPRIM | ID: wpr-763434

ABSTRACT

BACKGROUND/AIMS: Evidence that general anesthesia (GA) reduces the operative time of esophageal endoscopic submucosal dissection (ESD) is currently insufficient. This study aims to evaluate the efficacy and safety of esophageal ESD under GA. METHODS: A total of 227 lesions from 198 consecutive patients with superficial esophageal neoplasms treated by ESD at 3 Japanese institutions between April 2011 and September 2017 were included in this retrospective study. For ESD, GA and deep sedation (DS) were used in 102 (51.5%, GA group) and 96 patients (48.5%, DS group), respectively. RESULTS: There were no statistically significant differences in age, sex, or comorbidities between the groups. In the GA group, the tumor size was larger (21 [3–77] mm vs. 14 [3–63] mm, p<0.001), luminal circumference was larger (≥2/3; 13.9% vs. 5.4%, p=0.042), procedure time was shorter (28 [5–202] min vs. 40 [8–249] min, p<0.001), and submucosal dissection speed was faster (25.2 [7.8–157.2] mm² /min vs. 16.2 [2.4–41.3] mm² /min, p<0.001). The rates of intraoperative perforation and aspiration pneumonia were lower in the GA group, but the difference did not achieve statistical significance (p=0.242 and p=0.242). CONCLUSIONS: GA shortens the procedure time of esophageal ESD.


Subject(s)
Anesthesia , Anesthesia, General , Asian Continental Ancestry Group , Comorbidity , Deep Sedation , Esophageal Neoplasms , Humans , Operative Time , Phenobarbital , Pneumonia, Aspiration , Retrospective Studies
7.
Article in English | WPRIM | ID: wpr-762634

ABSTRACT

OBJECTIVE: To investigate the proportion of aspiration pneumonia cases among patients with community-acquired pneumonia in Korea. METHODS: This retrospective study included patients with community-acquired pneumonia who had been admitted to the emergency department of a university-affiliated tertiary hospital in Gyeonggi Province, Korea between January 1, 2016 and December 31, 2016. Among these patients, those with aspiration pneumonia were identified using ICD-10 codes (J69.*). Patients with recurrent pneumonia were excluded, as were those who were immunocompromised. The proportion of cases of aspiration pneumonia was calculated, and the characteristics and clinical outcomes of patients with aspiration pneumonia and non-aspiration pneumonia were compared. RESULTS: The proportion of aspiration pneumonia cases among patients with community-acquired pneumonia was 14.2%. Patients with aspiration pneumonia were significantly more likely to be older (p<0.001) and male (p<0.001), and to have a higher confusion, uremia, respiratory rate, blood pressure, and age ≥65 years (CURB-65) score (p<0.001) as compared to patients with non-aspiration pneumonia. They were also more likely to require admission to the intensive care unit (p<0.001) and a longer hospital stay (p<0.001). CONCLUSION: Aspiration pneumonia accounts for 14.2% of all cases of community-acquired pneumonia in Korea. These data may contribute to the establishment of healthcare strategies for managing aspiration pneumonia among Korean adults.


Subject(s)
Adult , Blood Pressure , Community-Acquired Infections , Delivery of Health Care , Emergency Service, Hospital , Humans , Intensive Care Units , International Classification of Diseases , Korea , Length of Stay , Male , Pneumonia , Pneumonia, Aspiration , Respiratory Rate , Retrospective Studies , Tertiary Care Centers , Uremia
8.
Article in English | WPRIM | ID: wpr-766401

ABSTRACT

Swallowing can be affected by a variety of systemic diseases. The etiology of dysphagia in the geriatric population is usually overlooked due mainly to a presumed diagnosis of presbyphagia or difficulty in revealing the direct cause. On the other hand, dysphagia can be a meaningful clinical sign of premalignant systemic disease. A 78-year-old man, without any prior medical or family history, was admitted with the chief complaint of dysphagia with recent aspiration pneumonia. Instrumental swallowing tests revealed a severe degree of dysphagia due to decreased laryngopharyngeal sensation and weakness of the pharyngeal constrictor muscles. Extensive workup, including electromyography and laboratory tests, revealed severe sensorimotor peripheral polyneuropathy related to monoclonal gammopathy. Monoclonal gammopathy of undetermined significance (MGUS) is a premalignant precursor of multiple myeloma, which is characterized by the proliferation of monoclonal proteins. These conditions are often associated with peripheral polyneuropathy, ataxia, and sometimes even muscle weakness. Although dysphagia can occur in other systemic disorders, such as vasculitis or paraneoplastic syndrome-related malignancies, there are few reports of dysphagia related to MGUS. The patient was followed up for three years. The MGUS showed no further progression, but the patient showed no improvement, indicating a protracted clinical course and poor prognosis when dysphagia is related to MGUS.


Subject(s)
Aged , Ataxia , Deglutition , Deglutition Disorders , Diagnosis , Electromyography , Hand , Humans , Monoclonal Gammopathy of Undetermined Significance , Multiple Myeloma , Muscle Weakness , Muscles , Paraproteinemias , Pneumonia, Aspiration , Polyneuropathies , Prognosis , Sensation , Vasculitis
9.
Einstein (Säo Paulo) ; 17(3): eAO4467, 2019. tab, graf
Article in English | LILACS | ID: biblio-1012001

ABSTRACT

ABSTRACT Objective: To evaluate clinical stability of neurologically impaired children and adolescents with recurrent pneumonia submitted to laryngotracheal separation. Methods: Between October 2002 and June 2015, 92 neurologically impaired children from a reference service, with median age of 68.5 months were submitted to laryngotracheal separation. Data were evaluated and statistical analysis was made by Student's t test and Pearson's χ2 test (significance level adopted of 95%). Results: Fifty-three children were male (57.6%). Forty-six children required admission to intensive care, and 42.4% needed mechanical ventilation. We observed that 90.2% of patients were exclusively fed by gastrostomy and 72.4% of the gastrostomies were performed before the tracheal surgery. Thirteen (14.1%) children had postoperative complications as follows: fistulae (5.4%), bleeding (4.3%), granuloma (2.2%) and stenosis (3.2%). A total of 24 patients had pneumonia in the postoperative period (26.1%), but there was a significant drop in occurrence of this condition after surgery (100% versus 26.1%; p<0.001). Twenty-three patients (25%) died. Postoperative complications were similar when comparing patients who died and those that presented good outcome (16.7% versus 13.2%; p=0.73). Conclusion: When well-indicated, the laryngotracheal separation reduces the incidence of postoperative pulmonary infections, thus improving quality of life and reducing admissions to hospital. Laryngotracheal separation should be indicated as a primary procedure in patients with cerebral palsy and recurrent aspiration pneumonia.


RESUMO Objetivo: Avaliar a estabilidade clínica da criança e do adolescente neuropata com episódios de pneumonia de repetição submetidos a procedimento cirúrgico de separação laringotraqueal. Métodos: Entre outubro 2002 a junho 2015, 92 crianças neuropatas de um único serviço com idade mediana de 68,5 meses foram submetidas à separação laringotraqueal. Os dados foram avaliados e foi realizada análise estatística pelo teste t de Student e pelo teste do χ2 de Pearson, com nível de significância adotado de 95%. Resultados: Dentre as 92 crianças, 53 eram do sexo masculino (57,6%). Quarenta e seis crianças necessitaram de internação em unidade de terapia intensiva, e 42,4% fizeram uso de ventilação mecânica. Dessas crianças, 90,2% alimentavam-se exclusivamente via gastrostomia, e 72,4% foram realizadas antes da separação laringotraqueal. As complicações pós-operatórias ocorreram em 13 crianças (14,1%), na seguinte ordem: fístula (5,4%), sangramento (4,3%), granuloma (2,2%) e estenose (3,2%). Observaram-se 24 episódios de pneumonia no período pós-operatório (26,1%). Houve diminuição significativa de ocorrência de pneumonias após a cirurgia (100% versus 26,1%, p<0,001). Óbito foi registrado em 23 pacientes (25%). A frequência de complicações pós-operatórias foi semelhante entre os pacientes que evoluíram ou não para óbito (16,7% versus 13,2%; p=0,73). Conclusão: A cirurgia bem indicada reduz o número de infecção pulmonar após o procedimento, melhorando a qualidade de vida desses pacientes e, consequentemente, reduzindo o número de internações. A separação laringotraqueal deve ser indicada como procedimento primário nos pacientes com paralisia cerebral e episódios repetidos de pneumonia aspirativa.


Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Pneumonia, Aspiration/surgery , Trachea/surgery , Larynx/surgery , Postoperative Complications , Quality of Life , Recurrence , Central Nervous System Diseases/surgery , Reproducibility of Results , Retrospective Studies , Treatment Outcome
10.
Audiol., Commun. res ; 24: e2258, 2019.
Article in Portuguese | LILACS | ID: biblio-1100893

ABSTRACT

RESUMO Objetivo apresentar o Protocolo de Prevenção de Broncoaspiração (PPB), visando estabelecer um fluxo padronizado para o manejo do paciente com risco de broncoaspiração. Esse protocolo, de aplicabilidade multiprofissional, estabelece um padrão assistencial de práticas clínicas para garantir a segurança do paciente em unidades de terapia intensiva (UTI), unidades de internação (UI) e pronto-socorro (PS). Métodos na admissão do paciente, ou durante sua permanência hospitalar, a equipe multiprofissional deverá observar se o paciente se encaixa em, pelo menos, UM dos critérios de inclusão do PPB. Caso o paciente seja identificado como em risco de broncoaspiração, a equipe de enfermagem deverá sinalizá-lo com a Pulseira do Risco de Broncoaspiração (cor cinza/prata). Resultados o PPB já foi aprovado pela Comissão de UTI Cirúrgica e pelo Serviço de Controle de Infecção Hospitalar (SCCIH) do Instituto Central do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (ICHCFMUSP). Com isso, o PPB mostrou-se factível, de baixo custo e efetivo em sua proposta. Conclusão a aplicabilidade do PPB nas Unidades de Terapia Intensiva, Unidades de Internação e Pronto-Socorro do ICHCFMUSP é uma iniciativa pioneira. O uso do protocolo e da pulseira é uma conquista para a Fonoaudiologia e a consolidação da sua existência nas unidades de internação hospitalar.


ABSTRACT Purpose To present the Bronchoaspiration Prevention Protocol (PPB) for the management of patients at risk of brochoaspiration. This protocol has a multidisciplinary approach and aims to standardize clinical practice in order to ensure patients' safety in Inpatient, Emergency and Intensive Care Units (ICUs). Methods Upon admission or during patients' hospital stay, the multidisciplinary team must observe if the patient presents at least one of the inclusion criteria for the PPB. In case the patient is classifies as at risk of bronchoaspiration, the nursing team will identify the patient with the silicone Bracelet for Risk of Bronchoaspiration (grey/silver color). Results The PPB has already been approved by the Instituto Central do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (ICHC FMUSP) ICU Commission and Hospital Infection Control Service (HICS). The PPB proved to fulfil its purpose in a viable, low-cost and effective manner. Conclusion Applicability of the PPB in Inpatient, Emergency and Intensive Care Units (ICUs) is a pioneer initiative. The use of the protocol and bracelet is an achievement for the Speech-Language and Hearing Sciences and consolidates our existence in the inpatient hospital setting.


Subject(s)
Humans , Patient Identification Systems/methods , Pneumonia, Aspiration/prevention & control , Patient Safety , Hospital Units , Patient Care Team , Deglutition Disorders/prevention & control , Risk , Patient Selection
11.
Rev. otorrinolaringol. cir. cabeza cuello ; 78(2): 174-179, jun. 2018. ilus
Article in Spanish | LILACS | ID: biblio-961611

ABSTRACT

RESUMEN Las hendiduras laríngeas posteriores son anomalías congénitas de la laringe de baja incidencia que comprometen la región interaritenoidea o la lámina cricoidea. En caso de extenderse hasta la tráquea son denominados clefts laringo-tráqueo-esofágicos. Su clínica es inespecífica y debe sospecharse en todo niño con trastorno de deglución y neumonía aspirativa a repetición. A continuación, presentamos un caso de un cleft laríngeo tipo 2 tratado endoscópicamente.


ABSTRACT The posterior laryngeal clefts are congenital anomalies of the larynx of low incidence that comprise the interaritenoid region or the cricoid lamina. In case of extending to the trachea they are called laryngo-tracheo-esophagic clefts. Its clinic is non-specific and should be suspected in any child with swallowing disorder and aspiration pneumonia. We present a case of an endoscopically treated laryngeal cleft type 2.


Subject(s)
Humans , Male , Infant , Congenital Abnormalities/surgery , Congenital Abnormalities/diagnosis , Larynx/abnormalities , Larynx/surgery , Pneumonia, Aspiration/etiology , Deglutition Disorders/etiology , Endoscopy/methods , Laser Therapy
14.
Neumol. pediátr. (En línea) ; 13(1): 11-14, ene. 2018. ilus
Article in Spanish | LILACS | ID: biblio-999205

ABSTRACT

Aspiration pulmonary disease is the condition in which there is a passage of gastric or oral content to the airways; the extent of aspiration is conditioned by the amount and frequency with which it occurs. The diagnostic approach of this pathology begins with an adequate clinical history with special emphasis on pathologies that generate poor swallowing mechanics such as neurological diseases, esophageal atresia and patients with a history of gastroesophageal reflux. The studies used for the diagnosis of this syndrome are chest X-ray, swallowing mechanics evaluation with barium, Ph-metry, scintigraphy with Tc99 for gastroesophageal reflux, delayed pulmonary scanning, endoscopic study of the digestive tract and bronchoscopy in search of lesions in the respiratory mucosa and bronchial lavage to detect lipid-laden alveolar macrophages which have been linked to the presence of aspiration syndromes in several publications


La neumopatía por aspiración es la condición en la que existe un paso de contenido gástrico a la vía aérea. La magnitud de la aspiración depende de la cantidad y la frecuencia con la que se presenta. El abordaje diagnóstico de esta patología se inicia con una historia clínica adecuada con especial énfasis en patologías que generen una mala mecánica de deglución como pueden ser enfermedades neurológicas, atresia esofágica y pacientes con antecedentes de reflujo gastroesofágico. Los estudios que se requieren para el diagnóstico de esta enfermedad constan de radiografía de tórax, estudio de deglución, Ph-metria, gamagrama para reflujo, estudio endoscópico de vía digestiva y broncoscopia en búsqueda de lesiones en la mucosa respiratoria y realización de lavado bronquial para macrófagos alveolares cargados de lípidos


Subject(s)
Humans , Child , Pneumonia, Aspiration/diagnosis , Pneumonia, Aspiration/etiology , Pneumonia, Aspiration/diagnostic imaging , Gastroesophageal Reflux/complications , Lipids/analysis
15.
Article in Korean | WPRIM | ID: wpr-715943

ABSTRACT

Radiation therapy is a common and effective treatment for various types of head and neck cancers. On the other hand, it usually leads to radiation therapy-induced dysphagia, which manifests as symptoms of obstruction or difficulty in swallowing. Dysphagia may cause several clinical problems, including depression and anxiety disorder, which can degrade a patient's quality of life (QOL). Furthermore, dysphagia may result in malnutrition, dehydration and weight loss, and eventually accelerate the disease. Therefore, it is important to identify the options for measurement and monitoring the nutritional status of dysphagia patients and determine clinically feasible interventions for nutritional supplement. A careful review of the literature provided several important implications. A nasogastric (NG) tube and percutaneous endoscopic gastrostomy (PEG) are useful options for providing nutritional supplement. In addition, continuous monitoring should be given to patients undergoing enteral nutritional support to check the degree to which nutrition supply, aspiration pneumonia or intrinsic enteral nutrition is supplemented. Several special forms of dysphagia diets may also serve as well-balanced nutrition care. Dysphagia patients may be provided with oral nutrition supplement (ONS), including intensified nutritional element, coupled with their preference for tastes and types of viscosity texture.


Subject(s)
Anxiety Disorders , Deglutition , Deglutition Disorders , Dehydration , Depression , Diet , Enteral Nutrition , Gastrostomy , Hand , Head , Humans , Malnutrition , Neck , Nutritional Status , Nutritional Support , Pneumonia, Aspiration , Quality of Life , Viscosity , Weight Loss
16.
Article in English | WPRIM | ID: wpr-715941

ABSTRACT

OBJECTIVE: Dysphagia after stroke can cause a range of complications, especially aspiration pneumonia, which can be life-threatening. Therefore, rehabilitation methods to reduce aspiration in patients with dysphagia are important. This study examined the effects of neuromuscular electrical stimulation combined with saliva or dry swallowing on the swallowing function of stroke patients with dysphagia. METHODS: The participants were assigned to either the experimental group (n=9) or control group (n=8). The experimental group received neuromuscular electrical stimulation combined with saliva or dry swallowing, whereas the control group received only voluntary swallowing. Both groups received training 5 days per week for 4 weeks. The oropharyngeal swallowing function was assessed using the video fluoroscopic dysphagia scale (VDS) and penetration-aspiration scale (PAS) based on a video fluoroscopic swallowing study. RESULTS: After the intervention, the experimental group showed greater improvement in the pharyngeal phase of the VDS and PAS scores than the control group (P=0.038, 0.027, respectively). CONCLUSION: Neuromuscular electrical stimulation combined with saliva or dry swallowing improves the pharyngeal swallowing function of stroke patients with dysphagia better than saliva or dry swallowing alone.


Subject(s)
Deglutition Disorders , Deglutition , Electric Stimulation , Humans , Pneumonia, Aspiration , Rehabilitation , Saliva , Stroke
17.
Article in English | WPRIM | ID: wpr-715937

ABSTRACT

Musculoskeletal symptoms, such as muscle weakness, stiffness and pain, are observed frequently in patients with hypothyroidism. In theory, hypothyroidism can cause weakness of the swallowing muscles, but dysphagia associated with hypothyroidism-associated myopathy has not been reported. The present case involved a 51-year-old man who experienced acute onset of severe dysphagia with aspiration pneumonia. A video fluoroscopic swallowing study and fiberoscopic endoscopic evaluation of swallowing revealed pharyngo-laryngeal function impairment. With a prior history of subclinical hypothyroidism and clinical symptoms such as proximal limb weakness, further evaluation involving a hormonal study, electrodiagnostic study, and histopathology assessment revealed myopathy. Hormone replacement therapy was started and the patient recovered within three weeks of treatment and was taking a regular diet. In conclusion, this study suggests that it is necessary to consider further evaluations to determine if hypothyroid myopathy is involved in the case of unknown origin dysphagia accompanied by hypothyroid myopathy.


Subject(s)
Deglutition Disorders , Deglutition , Diet , Extremities , Hormone Replacement Therapy , Humans , Hypothyroidism , Middle Aged , Muscle Weakness , Muscles , Muscular Diseases , Pneumonia, Aspiration
18.
Article in English | WPRIM | ID: wpr-719084

ABSTRACT

PURPOSE: To evaluate the association between neutrophil-to-lymphocyte ratio (NLR) and occurrence of aspiration pneumonia in drug intoxication (DI) patients in the emergency department (ED) and to evaluate the relationship between NLR and length of hospital admission/intensive care unit (ICU) admission. METHODS: A total of 466 patients diagnosed with DI in the ED from January 2016 to December 2017 were included in the analysis. The clinical and laboratory results, including NLR, were evaluated as variables. NLR was calculated as the absolute neutrophil count/absolute lymphocyte count. To evaluate the prognosis of DI, data on the development of aspiration pneumonia were obtained. Also, we evaluated the relationship between NLR and length of hospital admission and between NLR and length of ICU admission. Statistically, multivariate logistic regression analyses, receiver-operating characteristic (ROC) curve analysis, and Pearson's correlation (ρ) were performed. RESULTS: Among the 466 DI patients, 86 (18.5%) developed aspiration pneumonia. Multivariate logistic regression analysis revealed NLR as an independent factor in predicting aspiration pneumonia (odds ratio, 1.7; p=0.001). NLR showed excellent predictive performance for aspiration pneumonia (areas under the ROC curves, 0.815; cut-off value, 3.47; p 3.47).


Subject(s)
Emergencies , Emergency Medicine , Emergency Service, Hospital , Humans , Logistic Models , Lymphocyte Count , Neutrophils , Pneumonia, Aspiration , Prognosis , ROC Curve , Sensitivity and Specificity
19.
Article in Korean | WPRIM | ID: wpr-758497

ABSTRACT

BACKGROUND AND OBJECTIVES: The effect of palliative injection laryngoplasty in cancer-related unilateral vocal cord paralysis patients on voice and swallowing function is uncertain and there are few previous studies of its suitability, benefits as a palliative treatment option. The purpose of this study is to confirm the objective results of voice and swallowing function after palliative office-based hyaluronic acid injection laryngoplasty in cancer-related unilateral vocal cord paralysis patients. MATERIALS AND METHOD: 36 patients who had unilateral vocal cord paralysis from non-thyroidal, extralaryngeal neoplasms were included in this study. To evaluate the clinical outcome, we analyzed perceptual GRBAS grading, acoustic analysis, aerodynamic study, Electroglottography (EGG), Voice Handicap Index (VHI-30) about voice function and disability rating scale (DRS), gastric tube dependency, aspiration pneumonia about swallowing function and 36-Item Short Form Survey version 2 (SF-36v2) about quality of life. RESULTS: In GRBAS scale, G (p < 0.001), R (p=0.004), B (p=0.001), A (p=0.011), and S (p=0.007) showed significant improvement. Jitter, shimmer, speaking fundamental frequency, maximal phonation time, VHI-30, DRS score, gastric tube dependency, aspiration pneumonia, and SF-36v2 were significantly improved after injection (p=0.016, p=0.011, p=0.045, p=0.005, p < 0.001, p < 0.001 p=0.003, p < 0.001, and p < 0.001 respectively). CONCLUSION: From this study we concluded office-based hyaluronic acid injection can be used as a useful palliative treatment option in cancer-related ill patients with unilateral vocal cord paralysis. Palliative hyaluronic acid injection laryngoplasty avoids the need for tube feeding, thus reducing the risk of aspiration pneumonia. These outcomes are accompanied by significant improvement in voice quality.


Subject(s)
Acoustics , Deglutition , Enteral Nutrition , Humans , Hyaluronic Acid , Laryngoplasty , Methods , Palliative Care , Phonation , Pneumonia, Aspiration , Quality of Life , Vocal Cord Paralysis , Voice , Voice Quality
20.
Article in Korean | WPRIM | ID: wpr-766398

ABSTRACT

Caustic injury and spinal cord injury may induce pharyngeal and esophageal dysfunction, which frequently elicit dysphagia. Among the causes of dysphagia, these types of injury are related to anatomical and functional deterioration of the peripheral muscles and nerves. Various types of chemical materials cause upper aerodigestive tract burns, which induces stricture and dysphagia by scar formation. Endoscopic evaluation within 48 hours helps to predict the occurrence of stricture and dysphagia. The extent of injury or other additional complications should be assessed by plain X-ray and comupterized tomography (CT). The prevention of stricture, perforation, and dysphagia is a mainstay of treatment to reduce morbidity, and serial dilation with esophagogram and flap reconstruction should be considered in failure cases. Cervical spine injury itself causes mucosal tears or neuromuscular dysfunction, which can occur even during corrective surgery. Perforation should be evaluated by laryngoscopy, swallowing studies, plain X-ray, and CT. Both mechanical and functional obstruction that occur during the healing process can be managed by rehabilitative or surgical approaches. Dysphagia caused by chemical burns or cervical spine injury can provoke secondary complications such as aspiration pneumonia and malnutrition. Thus, adequate evaluation and management of anatomical and functional changes are required to prevent dysphagia and further complications, as well as to increase the quality of life of patients.


Subject(s)
Burns , Burns, Chemical , Cicatrix , Constriction, Pathologic , Deglutition , Deglutition Disorders , Humans , Laryngoscopy , Malnutrition , Muscles , Pneumonia, Aspiration , Quality of Life , Spinal Cord Injuries , Spine , Tears
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