Assessment of dysphagia with the use of pulse oximetry.

Recent anecdotal literature has shown a relation between arterial oxygen saturation (SpO2), as measured by pulse oximetry, and aspiration during eating. The present study was designed to determine whether bedside pulse oximetry has a role in the assessment of pharyngeal phase dysphagia. Forty-six adult patients with clinically suspected swallowing abnormalities underwent modified barium swallow to evaluate dysphagia. After determining baseline oxygen saturation by pulse oximetry, different consistencies of barium were sequentially ingested. Patients were monitored for radiographic evidence of penetration or aspiration, which was correlated with continuous SpO2 recording. Patients who exhibited aspiration or penetration without clearing had a significant decline in SpO2 compared with those patients who penetrated but cleared or in whom no penetration was observed. These relations were not associated with age, gender, or diagnosis. These preliminary data indicate that bedside pulse oximetry may be a useful tool in the evaluation of patients with dysphagia.

Safety profile of piperacillin/tazobactam in phase I and III clinical studies.

The safety of piperacillin/tazobactam was investigated in Phase I and Phase III clinical studies. In 22 Phase I pharmacokinetic studies, 242 healthy subjects and 232 patients were given single and multiple doses of piperacillin/tazobactam, piperacillin alone, tazobactam alone, and/or placebo. Interaction with tobramycin and vancomycin was also studied. Of 1201 patients enrolled in Phase III trials, 944 received piperacillin 4 g plus tazobactam 500 mg every 8 h for lower respiratory tract infections, complicated urinary tract infections, skin and soft tissue infections, and intra-abdominal infections, or piperacillin 2 g plus tazobactam 500 mg 8 hourly for less severe infections; 90 patients received imipenem/cilastatin as a comparative regimen. Piperacillin 4 g and tazobactam 500 mg were also administered every 6 h with an aminoglycoside to 167 patients with pulmonary infection or neutropenia and bacterial infection. In all trials, piperacillin/tazobactam was found to be safe and well tolerated. One death was deemed possibly drug-related. Thirty-eight patients were withdrawn from the trials because of adverse experiences, most often diarrhoea and allergic skin reactions. The commonest laboratory abnormalities related to liver function. The safety of piperacillin/tazobactam appears similar to that of other beta-lactam/beta-lactamase inhibitor combinations.