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1.
Appl Nurs Res ; 67: 151611, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-36116866

RESUMO

AIM: This study explored relationships between enteral feeding and tracheal pepsin A. BACKGROUND: Mechanically ventilated (MV) patients receiving enteral feeding are at risk for microaspiration. Tracheal pepsin A, an enzyme specific to gastric cells, was a proxy for microaspiration of gastric secretions. METHODS: Secondary analysis of RCT data from critically ill, MV adults was conducted. Microaspiration prevention included elevated head of bed, endotracheal tube cuff pressure management, and regular oral care. Tracheal secretions for pepsin A were collected every 12 h. Microaspiration was defined as pepsin A ≥ 6.25 ng/mL. Positive pepsin A in >30 % of individual tracheal samples was defined as abundant microaspiration (frequent aspirator). Chi-squared, Fisher's Exact test, and generalized linear model (GLM) were used. RESULTS: Tracheal pepsin A was present in 111/283 (39 %) mechanically ventilated patients and 48 (17 %) had abundant microaspiration. Enteral feeding was associated with tracheal pepsin A, which occurred within 24 h of enteral feeding. Of the patients who aspirated, the majority received some enteral feeding 96/111 (86 %), compared to only 15/111 (14 %) who received no feeding. A greater number of positive pepsin A events occurred with post-pyloric feeding tube location (55.6 %) vs. gastric (48.6 %), although significant only at the event-level. Frequent aspirators (abundant pepsin A) had higher pepsin A levels compared to infrequent aspirators. CONCLUSIONS: Our findings confirmed the stomach as the microaspiration source. Contrary to other studies, distal feeding tube location did not mitigate microaspiration. Timing for first positive pepsin A should be studied for possible association with enteral feeding intolerance.


Assuntos
Secreções Corporais , Estado Terminal , Nutrição Enteral , Pepsina A , Aspiração Respiratória de Conteúdos Gástricos , Traqueia , Adulto , Secreções Corporais/química , Secreções Corporais/metabolismo , Estado Terminal/terapia , Nutrição Enteral/efeitos adversos , Humanos , Recém-Nascido , Intubação Intratraqueal , Pepsina A/análise , Pepsina A/metabolismo , Aspiração Respiratória de Conteúdos Gástricos/etiologia , Aspiração Respiratória de Conteúdos Gástricos/metabolismo , Traqueia/metabolismo
3.
Anesth Analg ; 133(3): 581-591, 2021 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-34403386

RESUMO

Perioperative fasting guidelines are designed to minimize the risk of pulmonary aspiration of gastrointestinal contents. The current recommendations from the American Society of Anesthesiologists (ASA) and the European Society of Anaesthesiology and Intensive Care (ESAIC) are for a minimum 2-hour fast after ingestion of clear liquids before general anesthesia, regional anesthesia, or procedural sedation and analgesia. Nonetheless, in children, fasting guidelines also have consequences as regards to child and parent satisfaction, hemodynamic stability, the ability to achieve vascular access, and perioperative energy balance. Despite the fact that current guidelines recommend a relatively short fasting time for clear fluids of 2 hours, the actual duration of fasting time can be significantly longer. This may be the result of deficiencies in communication regarding the duration of the ongoing fasting interval as the schedule changes in a busy operating room as well as to poor parent and patient adherence to the 2-hour guidelines. Prolonged fasting can result in children arriving in the operating room for an elective procedure being thirsty, hungry, and generally in an uncomfortable state. Furthermore, prolonged fasting may adversely affect hemodynamic stability and can result in parental dissatisfaction with the perioperative experience. In this PRO and CON presentation, the authors debate the premise that reducing the nominal minimum fasting time from 2 hours to 1 hour can reduce the incidence of prolonged fasting and provide significant benefits to children, with no increased risks.


Assuntos
Anestesia/normas , Ingestão de Líquidos , Procedimentos Cirúrgicos Eletivos/normas , Jejum , Esvaziamento Gástrico , Cuidados Pré-Operatórios/normas , Aspiração Respiratória de Conteúdos Gástricos/prevenção & controle , Adolescente , Fatores Etários , Anestesia/efeitos adversos , Criança , Pré-Escolar , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Conteúdo Gastrointestinal , Humanos , Lactente , Recém-Nascido , Guias de Prática Clínica como Assunto , Cuidados Pré-Operatórios/efeitos adversos , Aspiração Respiratória de Conteúdos Gástricos/etiologia , Medição de Risco , Fatores de Risco , Fatores de Tempo
5.
Lung ; 199(2): 139-145, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33751204

RESUMO

INTRODUCTION: Previously described methodologies for detecting laryngopharyngeal reflux (LPR) have limitations. Symptoms alone are non-diagnostic, and pH-impedance studies have poor sensitivity. Pulmonary micro-aspiration is under-recognised in LPR and gastro-esophageal reflux disease (GERD). The present study aimed to describe the results of a modified technique for scintigraphic reflux studies in two groups with severe reflux: those with typical reflux symptoms and those with laryngopharyngeal manifestations of reflux. METHODS: A prospective database of severely symptomatic, treatment-resistant reflux patients was grouped based upon predominant symptom profile of typical GERD or LPR. All patients underwent reflux scintigraphy. Results were obtained for early scintigraphic reflux contamination of the pharynx and proximal esophagus, and delayed contamination of the pharynx and lungs after 2 h. RESULTS: 187 patients were studied (82 GERD, 105 LPR). The LPR patients were predominantly female (70.5% vs. 56.1%; p = 0.042) and older than the GERD group (median age 60 years vs. 55.5 years; p = 0.002). Early scintigraphic reflux was seen at the pharynx in 89.2% (GERD 87.7%, LPR 90.4%; p = 0.133), and at the proximal esophagus in 89.7% (GERD 88.9%, LPR 90.4%; p = 0.147). Delayed contamination of the pharynx was seen in 95.2% (GERD 93.9%, LPR 96.2%; p = 0.468). Delayed pulmonary aspiration was seen in 46% (GERD 36.6%, LPR 53.3%; p = 0.023). CONCLUSION: Reflux scintigraphy demonstrated a high rate of reflux-related pulmonary aspiration. Contamination of the proximal esophagus and pharynx was observed frequently in both groups of severe disease. The likelihood of pulmonary aspiration and potential pulmonary disease needs to be entertained in severe GERD and LPR.


Assuntos
Aspiração Respiratória de Conteúdos Gástricos/diagnóstico por imagem , Tomografia Computadorizada com Tomografia Computadorizada de Emissão de Fóton Único , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Bases de Dados Factuais , Esôfago/diagnóstico por imagem , Esôfago/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Faringe/diagnóstico por imagem , Faringe/fisiopatologia , Estudos Prospectivos , Aspiração Respiratória de Conteúdos Gástricos/etiologia , Aspiração Respiratória de Conteúdos Gástricos/fisiopatologia , Avaliação de Sintomas , Adulto Jovem
6.
Anesth Analg ; 133(3): 690-697, 2021 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-33591115

RESUMO

BACKGROUND: Tools for the evaluation of gastric emptying have evolved over time. The purpose of this study was to show that the risk of pulmonary aspiration is not increased with carbohydrate drink, by demonstrating that the gastric antral cross-sectional area (CSA) of the NO-NPO group is either equivalent to or less than that of the NPO (nil per os) group. METHODS: Sixty-four patients scheduled for elective laparoscopic benign gynecologic surgery were enrolled and randomly assigned to the NPO group (n = 32) or the NO-NPO group (n = 32). After having a regular meal until midnight before surgery, the NPO group fasted until surgery, while the NO-NPO group ingested 400 mL of a carbohydrate drink at midnight and freely up to 2 hours before anesthesia. The primary outcome was the gastric antral CSA by gastric ultrasound in right lateral decubitus position (RLDP). Noninferiority was defined as a mean difference of CSA <2.8 cm2. Secondary outcomes included CSA in supine position, gastric volume (GV), GV per weight (GV/kg), GV/kg >1.5 mL/kg, and Perlas grade. RESULTS: CSA in RLDP was not different between the NPO group (6.25 ± 3.79 cm2) and the NO-NPO group (6.21 ± 2.48 cm2; P = .959). The mean difference of CSA in RLDP (NO-NPO group - NPO group) was 0.04 (95% confidence interval [CI], -1.56 to 1.64), which was within the noninferiority margin of 2.8 cm2. CSA was not different between the 2 groups (4.17 ± 2.34 cm2 in NPO group versus 4.28 ± 1.23 cm2 in NO-NPO group; P = .828). GV in NPO group (70 ± 56 mL) was not different from NO-NPO group (66 ± 36 mL; mean difference, 3.66; 95% CI, -20 to 27; P = .756). GV/kg in the NPO group (1.25 ± 1.00 mL/kg) was not different from the NO-NPO group (1.17 ± 0.67 mL/kg; P = .694). The incidence of GV/kg > 1.5 mL/kg was not different between NPO (31.3%) and NO-NPO group (21.9%; P = .768). The median (interquartile range) of the Perlas grade was 1 (0-1) in NPO group and 0.5 (0-1) in NO-NPO group (P = .871). CONCLUSIONS: Preoperative carbohydrates ingested up to 2 hours before anesthesia do not delay gastric emptying compared to midnight fasting, as evaluated with gastric ultrasound.


Assuntos
Bebidas , Carboidratos da Dieta/administração & dosagem , Esvaziamento Gástrico , Cuidados Pré-Operatórios , Aspiração Respiratória de Conteúdos Gástricos/prevenção & controle , Estômago/diagnóstico por imagem , Ultrassonografia , Adulto , Bebidas/efeitos adversos , Carboidratos da Dieta/efeitos adversos , Método Duplo-Cego , Feminino , Conteúdo Gastrointestinal , Procedimentos Cirúrgicos em Ginecologia , Humanos , Laparoscopia , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Cuidados Pré-Operatórios/efeitos adversos , Estudos Prospectivos , Aspiração Respiratória de Conteúdos Gástricos/etiologia , Aspiração Respiratória de Conteúdos Gástricos/fisiopatologia , Medição de Risco , Fatores de Risco , Seul , Estômago/fisiopatologia , Fatores de Tempo
7.
Thorac Cardiovasc Surg ; 69(3): 204-210, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-32593178

RESUMO

OBJECTIVES: Aspirations are common after esophagectomy. Data are lacking regarding its long-term radiological manifestations. The purpose of this study is to determine the incidence and radiological patterns of aspirations among long-term survivors and evaluate their clinical significance. METHODS: The records of all patients who underwent esophagectomy between October 2003 and December 2011 and survived more than 3 years were reviewed. Preoperative, first routine postoperative, and latest chest computed tomography (CT)scans were reviewed. Imaging studies were reviewed for radiological signs suspicious of aspirations, conduit location, anastomotic site, and maximal intrathoracic diameter. Data regarding patients' complaints during clinic visits were also collected. RESULTS: A total of 578 patients underwent esophagectomy during the study period. One-hundred twenty patients met the inclusion criteria. Median follow-up was 83.5 months. Cervical and intrathoracic anastomoses were performed in 103 and 17 patients, respectively. A higher rate of CT findings was found in postoperative imaging (n = 51 [42.5%] vs. n = 13 [10.8%] respectively, p < 0.05). Most of these were found in the lower lobes (61%). A higher rate of lesions was found among patients in whom the conduit was bulging to the right hemithorax compared with totally mediastinal or completely in the right hemithorax (54.5 vs. 35.2% and 34.6%, respectively, p < 0.05). No correlation was found with conduit diameter or anastomotic site. These lesions were more prevalent among patients who complained of reflux or cough during meals (NS). CONCLUSIONS: A significantly higher rate of new CT findings was found in postoperative imaging of this post-esophagectomy cohort, suggesting a high incidence of aspirations. The locations of the conduit, rather than anastomosis site, seem to play a role in the development of these findings. Further research is needed to evaluate the clinical significance of these findings.


Assuntos
Fístula Anastomótica/diagnóstico por imagem , Esofagectomia/efeitos adversos , Esôfago/cirurgia , Aspiração Respiratória de Conteúdos Gástricos/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Idoso , Fístula Anastomótica/etiologia , Fístula Anastomótica/fisiopatologia , Deglutição , Esofagectomia/instrumentação , Esôfago/diagnóstico por imagem , Esôfago/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Valor Preditivo dos Testes , Aspiração Respiratória de Conteúdos Gástricos/etiologia , Aspiração Respiratória de Conteúdos Gástricos/fisiopatologia , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
8.
Neurogastroenterol Motil ; 31(12): e13707, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31482661

RESUMO

BACKGROUND: The pathophysiological mechanism(s) of gastroesophageal reflux disease (GERD)-related chronic cough (CC) is unclear. We aimed to determine the mechanism of reflux-induced cough by synchronous monitoring of reflux episodes, esophageal motility, and cough. METHODS: Patients with GERD were prospectively enrolled and classified into GERD with CC (GERD-CC) and without CC (GERD) groups. Twenty-four-hour ambulatory pH-impedance-pressure monitoring was performed; the reflux patterns, esophageal motility during prolonged exposure to acid and characteristics of reflux episodes that induced coughing paroxysms were analyzed. KEY RESULTS: Thirty-one patients with GERD-CC and 47 with GERD were enrolled; all of whose monitoring results fulfilled the criteria for diagnosis of GERD. Patients with GERD-CC had higher reflux symptom scores, longer exposure to acid, higher DeMeester scores, and more frequent reflux episodes, proximal extent reflux detected by impedance, and higher percentage of strongly acidic reflux than patients in the GERD group (all P < .05). Of 63 reflux-cough episodes identified in the GERD-CC group, 74.6% of distal reflux and 67.0% of proximal reflux episodes were acidic. More patients had low pan-esophageal pressure in primary peristalsis (48.5% vs 11.8%, P = .000) and synchronous contraction in secondary peristalsis during prolonged exposure to acid in the GERD-CC than in the GERD group (63.9% vs 9.1%, P = .000). CONCLUSIONS & INFERENCES: Proximal acidic reflux and distal reflux-reflex are jointly associated with reflux-induced cough in patients with GERD. Low pan-esophageal pressure in primary peristalsis and synchronous contraction in secondary peristalsis may play important roles in GERD-associated chronic cough.


Assuntos
Tosse/etiologia , Refluxo Gastroesofágico/complicações , Adolescente , Adulto , Idoso , Doença Crônica , Tosse/fisiopatologia , Impedância Elétrica , Transtornos da Motilidade Esofágica/complicações , Transtornos da Motilidade Esofágica/fisiopatologia , Monitoramento do pH Esofágico , Feminino , Refluxo Gastroesofágico/fisiopatologia , Conteúdo Gastrointestinal , Gastroscopia , Azia/etiologia , Azia/fisiopatologia , Humanos , Refluxo Laringofaríngeo/etiologia , Refluxo Laringofaríngeo/fisiopatologia , Masculino , Manometria/métodos , Pessoa de Meia-Idade , Monitorização Ambulatorial , Peristaltismo/fisiologia , Pressão , Estudos Prospectivos , Aspiração Respiratória de Conteúdos Gástricos/etiologia , Aspiração Respiratória de Conteúdos Gástricos/fisiopatologia , Adulto Jovem
9.
Neurogastroenterol Motil ; 31(12): e13713, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31464354

RESUMO

BACKGROUND: There is still a lack of a clinical test to reliably identify patients with Parkinson's disease (PD) being at risk for aspiration. METHODS: In this prospective, controlled, cross-sectional study, we assessed if swallowing speed for water is a useful clinical test to predict aspiration proven by flexible endoscopic evaluation of swallowing (FEES). Due to this, we measured the swallowing speed for 90 mL water in 115 consecutive and unselected PD outpatients of all clinical stages and 32 healthy controls. KEY RESULTS: Average swallowing speed was lower in patients compared with controls (6.5 ± 3.9 mL/s vs 8.5 ± 3.2 mL/s; P < .01). The disease-independent widely used threshold of <10 mL/s showed insufficient sensitivity of 88% and specificity of 19% with high false-positive rates of 63% for patients and 69% for controls. Receiver operating characteristic (ROC) analysis was carried out to define a suitable cutoff value for detection of aspiration of water (area under the curve 0.72, P < .001) in PD patients. The optimized cutoff value was 5.5 mL/s with a sensitivity of 69% and a specificity of 64%. CONCLUSION AND INFERENCES: Measuring swallowing speed is prone to methodological errors and not suitable as a screening instrument to predict aspiration in PD patients.


Assuntos
Deglutição/fisiologia , Doença de Parkinson/fisiopatologia , Aspiração Respiratória de Conteúdos Gástricos/etiologia , Idoso , Área Sob a Curva , Estudos Transversais , Ingestão de Líquidos , Esofagoscopia , Reações Falso-Positivas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/complicações , Testes Imediatos , Valor Preditivo dos Testes , Estudos Prospectivos , Curva ROC , Aspiração Respiratória de Conteúdos Gástricos/fisiopatologia , Risco , Sensibilidade e Especificidade , Caracteres Sexuais
10.
Anaesthesiol Intensive Ther ; 51(2): 121-125, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31268273

RESUMO

BACKGROUND: The relationship between gastric fluid volume, volume of fluid regurgitated, and aspirated fluid volume remains unclear. Using a life-like manikin suitable for a pulmonary aspiration model, we aimed to assess the relationship between regurgitated and aspirated clear fluid volumes, and to determine the minimal value of the volume of liquid regurgitated that may lead to pulmonary aspiration of fluid volume ≥ 0.8 mL kg-1 (around 60 mL) that is likely to cause lung injury. METHODS: Several volumes of water ranging from 30 to 150 mL were injected in a randomized order, at a flow rate of 20 mL per second, into the esophagus of a manikin lying in the supine position on a non-tilted table, with the manikin head in the extension or in the sniffing position. Aspirated volumes were measured in the manikin bronchi, by an investigator blinded to the volume injected. Aspiration was defined as positive when the volume of collected water was ≥ 60 mL for at least one of the five injections of each volume of water. RESULTS: The minimal volume of water injected into the esophagus for an aspirated volume ≥ 0.8 mL kg-1 was 85 mL in the sniffing position, and was 150 mL in the extension position. CONCLUSIONS: These results suggest that the critical cut-off value of gastric fluid volume to be considered for the risk of significant pulmonary aspiration would be ≥ 85 mL (≥ 1 mL kg-1), in the sniffing position. These results should however be confirmed in further studies using other models.


Assuntos
Conteúdo Gastrointestinal/química , Postura/fisiologia , Aspiração Respiratória de Conteúdos Gástricos/etiologia , Água/química , Adulto , Humanos , Manequins , Posicionamento do Paciente
11.
Minerva Anestesiol ; 85(7): 756-762, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30938120

RESUMO

BACKGROUND: The aim of this study was to evaluate the use of laryngeal mask airway (LMA)® Protector™ by comparison with traditional LMA for performing endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). METHODS: This was a retrospective observational single-center study including 143 patients who underwent EBUS-TBNA for mediastinal staging of lung cancer. Patients were retrospectively divided into two groups based on whether a traditional LMA (traditional LMA group) or LMA Protector was used. Anesthesiologist outcomes, diagnostic yield of EBUS-TBNA, and complications related to the procedure were computed for each group and statistically compared. RESULTS: LMA traditional group and LMA Protector group counted 70 and 73 patients, respectively. LMA traditional group versus LMA Protector group showed no significant difference on time of LMA insertion (120±25 vs. 118±39 s; P=0.49), reposition rates (18% vs. 16%; P=0.78); systolic pressure (140±55 vs. 118±37 mmHg; P=0.59); diastolic pressure (82±15 vs. 90±26 mmHg; P=0.39); heart rate (82±9.9 vs. 83±20 bpm; P=0.49); SpO2 values (93±21% vs. 92±14%; P=0.63); diagnostic accuracy (91.3% vs. 92%; P=0.95), and patients' complications as nausea (4% vs. 3%; P=0.61); vomiting (3% vs. 1%, P=0.96); gastric aspiration (7% vs. 1%; P=0.08); and sore throat (7% vs. 3%; P=0.22). Conversely, LMA traditional group versus LMA Protector group presented a longer procedural time (47±23 vs. 38±17 s; P=0.02), higher number of passage to biopsy target lesion (4±0.5 vs. 3.1±0.6; P=0.01); higher rate of balloon ultrasound rupture (11% vs. 1%; P=0.01). CONCLUSIONS: EBUS-TBNA conducted with LMA Protector is a useful strategy that reduced the procedural time and in theory ensured the comfort of patients. Our results should be confirmed by larger, prospective, randomized studies.


Assuntos
Biópsia por Agulha/métodos , Brônquios , Endossonografia/métodos , Biópsia Guiada por Imagem/métodos , Máscaras Laríngeas , Idoso , Biópsia por Agulha/efeitos adversos , Sistemas Computacionais , Endossonografia/efeitos adversos , Desenho de Equipamento , Feminino , Hemodinâmica , Humanos , Máscaras Laríngeas/efeitos adversos , Neoplasias Pulmonares/patologia , Masculino , Náusea/etiologia , Estadiamento de Neoplasias/métodos , Faringe/lesões , Aspiração Respiratória de Conteúdos Gástricos/etiologia , Estudos Retrospectivos , Vômito/etiologia
12.
PLoS One ; 14(2): e0212704, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30811470

RESUMO

BACKGROUND: High-quality chest compressions are imperative for Cardio-Pulmonary-Resuscitation (CPR). International CPR guidelines advocate, that chest compressions should not be interrupted for ventilation once a patient's trachea is intubated or a supraglottic-airway-device positioned. Supraglottic-airway-devices offer limited protection against pulmonary aspiration. Simultaneous chest compressions and positive pressure ventilation both increase intrathoracic pressure and potentially enhances the risk of pulmonary aspiration. The hypothesis was, that regurgitation and pulmonary aspiration is more common during continuous versus interrupted chest compressions in human cadavers ventilated with a laryngeal tube airway. METHODS: Twenty suitable cadavers were included, and were positioned supine, the stomach was emptied, 500 ml of methylene-blue-solution instilled and laryngeal tube inserted. Cadavers were randomly assigned to: 1) continuous chest compressions; or, 2) interrupted chest compressions for ventilation breaths. After 14 minutes of the initial designated CPR strategy, pulmonary aspiration was assessed with a flexible bronchoscope. The methylene-blue-solution was replaced by 500 ml barium-sulfate radiopaque suspension. 14 minutes of CPR with the second designated ventilation strategy was performed. Pulmonary aspiration was then assessed with a conventional chest X-ray. RESULTS: Two cadavers were excluded for technical reasons, leaving 18 cadavers for statistical analysis. Pulmonary aspiration was observed in 9 (50%) cadavers with continuous chest compressions, and 7 (39%) with interrupted chest compressions (P = 0.75). CONCLUSION: Our pilot study indicate, that incidence of pulmonary aspiration is generally high in patients undergoing CPR when a laryngeal tube is used for ventilation. Our study was not powered to identify potentially important differences in regurgitation or aspiration between ongoing vs. interrupted chest compression. Our results nonetheless suggest that interrupted chest compressions might better protect against pulmonary aspiration when a laryngeal tube is used for ventilation.


Assuntos
Reanimação Cardiopulmonar/efeitos adversos , Parada Cardíaca/terapia , Refluxo Laringofaríngeo/epidemiologia , Respiração com Pressão Positiva/efeitos adversos , Aspiração Respiratória de Conteúdos Gástricos/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Cadáver , Reanimação Cardiopulmonar/instrumentação , Reanimação Cardiopulmonar/métodos , Estudos Cross-Over , Feminino , Humanos , Incidência , Máscaras Laríngeas/efeitos adversos , Refluxo Laringofaríngeo/etiologia , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Respiração com Pressão Positiva/instrumentação , Distribuição Aleatória , Aspiração Respiratória de Conteúdos Gástricos/diagnóstico por imagem , Aspiração Respiratória de Conteúdos Gástricos/etiologia
14.
Rev. chil. enferm. respir ; 34(2): 111-117, ago. 2018. tab
Artigo em Espanhol | LILACS | ID: biblio-959415

RESUMO

Resumen El reflujo gastroesofágico (RGE) y la aspiración oculta de contenido digestivo están probablemente implicados en la etiopatogenia y progresión de la fibrosis pulmonar idiopática (FPI). Los mecanismos patogénicos involucrados son la disminución de la distensibilidad pulmonar y el consiguiente aumento de la presión negativa intratorácica durante la inspiración, así como la disminución de los mecanismos de control de la motilidad esofágica o del tono del esfínter esofágico inferior. La prevalencia de RGE y anomalías de la motilidad esofágica están aumentadas en los pacientes con FPI comparado con la población general. Entre los pacientes con FPI, el 67-76% demostraron exposición anormal al contenido ácido en el esófago. Sin embargo, no hubo relación entre la gravedad del RGE y la gravedad de la FPI. Los estudios que han examinado el tratamiento antirreflujo en esta población han sido escasos. Incluso, algunos datos sugieren que el tratamiento antiácido puede ser perjudicial en algunos pacientes con esta condición. Después de analizar toda la evidencia relevante encontrada hasta la fecha, concluimos que no se puede establecer una relación causal entre el RGE, la aspiración del contenido gástrico y la patogénesis de la FPI. Además, existe escasa evidencia clínica que haya examinado el tratamiento antirreflujo en pacientes con fibrosis pulmonar idiopática.


ABSTRACT Gastroesophageal reflux (GERD) and hidden aspiration of gastric contents are probably involved in the pathogenesis and progression of idiopathic pulmonary fibrosis (IPF). The pathological mechanisms involved are decreased pulmonary distensibility and consequent increase of intrathoracic negative pressure during inspiration, as well as decreased control mechanisms of esophageal motility or lower esophageal sphincter. The prevalence of GERD and oesophageal dysmotility was higher in patients with IPF as compared with general population. Among patients with IPF, 67-76% demonstrated abnormal oesophageal acid exposure. However, no relationship was demonstrated between severity of GERD and severity of IPF. Data are scant on outcomes of antireflux treatment in patients with IPF. Actually, some data suggests that antacid treatment may be deleterious in some IPF patients. After analyzing all the relevant evidence found to date, a causal relationship between GERD, gastric content aspiration and IPF pathogenesis cannot be established. There is scant evidence examining antireflux treatment in idiopathic pulmonary fibrosis patients.


Assuntos
Humanos , Refluxo Gastroesofágico/complicações , Refluxo Gastroesofágico/fisiopatologia , Fibrose Pulmonar Idiopática/etiologia , Fibrose Pulmonar Idiopática/fisiopatologia , Aspiração Respiratória de Conteúdos Gástricos/complicações , Transtornos da Motilidade Esofágica/diagnóstico , Transtornos da Motilidade Esofágica/patologia , Progressão da Doença , Fibrose Pulmonar Idiopática/genética , Aspiração Respiratória de Conteúdos Gástricos/etiologia , Antiácidos
15.
Anaesthesia ; 73(10): 1229-1234, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30044502

RESUMO

Cricoid pressure is employed during rapid sequence induction to reduce the risk of pulmonary aspiration. Correct application of cricoid pressure depends on knowledge of neck anatomy and precise identification of surface landmarks. Inaccurate localisation of the cricoid cartilage during rapid sequence induction risks incomplete oesophageal occlusion, with potential for pulmonary aspiration of gastric contents. It may also compromise the laryngeal view for the anaesthetist. Accurate localisation of the cricoid cartilage therefore has relevance for the safe conduct of rapid sequence induction. We conducted a multicentre, prospective cohort study to determine the accuracy of cricoid cartilage identification in 100 patients. The cranio-caudal midpoint of the cricoid cartilage was identified by a qualified anaesthetic assistant using the conventional landmark technique and marked. While maintaining the patient in the same position, a second mark was made by identifying the midpoint of the cricoid cartilage using ultrasound scanning. The mean (SD) distance between the two marks was 2.07 (8.49) mm. In 41% of patients the midpoint was incorrectly identified by a margin greater than 5 mm. This error was uniformly distributed both above and below the midpoint of the cricoid cartilage. The Pearson correlation coefficient of this error with respect to body mass index was 0.062 (p = 0.539) and with age was -0.020 (p = 0.843). There were also no significant differences in error between male and female patients. Identification of cricoid position using a landmark technique has a high degree of variability and has little correlation with age, sex or body mass index. These findings have significant implications for the safe application of cricoid pressure in the context of rapid sequence induction.


Assuntos
Pontos de Referência Anatômicos/diagnóstico por imagem , Cartilagem Cricoide/diagnóstico por imagem , Adulto , Idoso , Anestesia Geral , Cartilagem Cricoide/anatomia & histologia , Feminino , Humanos , Intubação Intratraqueal/efeitos adversos , Intubação Intratraqueal/métodos , Masculino , Pessoa de Meia-Idade , Pressão , Estudos Prospectivos , Reprodutibilidade dos Testes , Aspiração Respiratória de Conteúdos Gástricos/etiologia , Aspiração Respiratória de Conteúdos Gástricos/prevenção & controle , Ultrassonografia/métodos
16.
Lung ; 196(4): 491-496, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29804143

RESUMO

PURPOSE: Pulmonary aspiration of gastric refluxate is one of the indications for anti-reflux surgery. Effectiveness of surgery in preventing pulmonary aspiration post-operatively has not been previously tested. The aim of this project is to assess effectiveness of anti-reflux surgery on preventing pulmonary aspiration of gastric refluxate. METHODS: Retrospective analysis of prospectively populated database of patients with confirmed aspiration of gastric refluxate on scintigraphy. Patients that have undergone anti-reflux surgery between 01/01/2014 and 31/12/2015 and had scintigraphy post-operatively were included. Objective data such as resolution of aspiration, degree of proximal aero-digestive contamination, surgical complications and oesophageal dysmotility as well as patient quality of life data were analysed. RESULTS: Inclusion criteria were satisfied by 39 patients (11 male and 28 female). Pulmonary aspiration was prevented in 24 out of 39 patients (61.5%) post-operatively. Significant reduction of isotope contamination of upper oesophagus supine and upright (p = 0.002) and pharynx supine and upright (p = 0.027) was confirmed on scintigraphy post-operatively. Severe oesophageal dysmotility was strongly associated with continued aspiration post-operatively OR 15.3 (95% CI 2.459-95.194; p = 0.02). Majority (24/31, 77%) of patients were satisfied or very satisfied with surgery, whilst 7/31 (23%) were dissatisfied. Pre-operative GIQLI scores were low (mean 89.77, SD 20.5), modest improvements at 6 months (mean 98.4, SD 21.97) and deterioration at 12 months (mean 88.41, SD 28.07) were not significant (p = 0.07). CONCLUSION: Surgery is partially effective in reversing pulmonary aspiration of gastric refluxate on short-term follow-up. Severe oesophageal dysmotility is a predictor of inferior control of aspiration with surgery.


Assuntos
Fundoplicatura/métodos , Refluxo Gastroesofágico/cirurgia , Laparoscopia , Aspiração Respiratória de Conteúdos Gástricos/prevenção & controle , Adulto , Idoso , Bases de Dados Factuais , Transtornos da Motilidade Esofágica/complicações , Transtornos da Motilidade Esofágica/fisiopatologia , Feminino , Fundoplicatura/efeitos adversos , Refluxo Gastroesofágico/complicações , Refluxo Gastroesofágico/diagnóstico por imagem , Refluxo Gastroesofágico/fisiopatologia , Humanos , Laparoscopia/efeitos adversos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Complicações Pós-Operatórias/etiologia , Recuperação de Função Fisiológica , Aspiração Respiratória de Conteúdos Gástricos/diagnóstico por imagem , Aspiração Respiratória de Conteúdos Gástricos/etiologia , Aspiração Respiratória de Conteúdos Gástricos/fisiopatologia , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
17.
Ann Ital Chir ; 89: 45-50, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29629894

RESUMO

BACKGROUND: The observation of a relatively high number of pulmonary aspirations (PA) among gastric band (GB) carriers undergoing a second surgery, prompted us to modify our strategy for GB patients candidate to further operation under general anesthesia. MATERIAL OF STUDY AND RESULTS: In January 2013, following the occurrence of PA at the induction of general anesthesia in 1 GB carrier undergoing a further operation, we reviewed our Data Base between January 2005 and 2013, to explore the rate of pulmonary aspiration in patients GB carriers undergoing a second surgery. Considering the rate (3/172 - 1.7%) too high in comparison with non-GB carriers, we decided to deflate the banding before any further surgery planned under general anesthesia. We then retrospectively reviewed the occurrence of PA after having changed the protocol. Since February 2013, through December 2016, 81 GB carriers underwent a second surgery and not a single episode of PA occurred (0/81). DISCUSSION: The occurrence of PA in patients with GB seems greater than in non-GB patients. Larger series should be examined to assess the incidence of PA among this specific population. Awareness of the increased risk is important to general anesthesiologists and surgeons, considering the increasing number of GB carriers who may be in need of surgery. Our result after adopting the deflation policy, even though not statistically significant, seems highly suggestive. CONCLUSION: We believe that, considering the potentially severe consequences of PA, the gastric band should be deflated before any planned procedure requiring general anesthesia. Further data are needed. KEY WORDS: Adjustable gastric banding, Aspiration Pneumonia, Bariatric surgery, Morbid obesity, Pulmonary Aspiration.


Assuntos
Gastroplastia/efeitos adversos , Complicações Intraoperatórias/etiologia , Aspiração Respiratória de Conteúdos Gástricos/etiologia , Anestesia Geral/efeitos adversos , Contorno Corporal , Colecistectomia , Protocolos Clínicos , Remoção de Dispositivo , Suscetibilidade a Doenças , Procedimentos Cirúrgicos Eletivos , Herniorrafia , Humanos , Hérnia Incisional/cirurgia , Complicações Intraoperatórias/epidemiologia , Complicações Intraoperatórias/prevenção & controle , Aspiração Respiratória de Conteúdos Gástricos/epidemiologia , Aspiração Respiratória de Conteúdos Gástricos/prevenção & controle , Estudos Retrospectivos
18.
J Stroke Cerebrovasc Dis ; 26(8): 1766-1772, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28456464

RESUMO

BACKGROUND: One of the major, and most harmful, symptoms of dysphagia in stroke survivors is aspiration. Survivors of unilateral cortical strokes with dysphagia and resulting aspiration have been reported to have greater initiation delays in laryngeal closure than those who did not aspirate. Few studies have reported such data in survivors of subcortical stroke. METHODS: This study measured initiation of laryngeal closure (ILC) and laryngeal closure duration (LCD) in 2 groups of subjects: 15 stroke survivors with cortical lesions and 15 stroke survivors with subcortical lesions. Means and standard deviations of ILC and LCD were analyzed on 5-mL thin liquid and 5-mL puree boluses using a 100-ms timer during subsequent analysis of videofluoroscopic swallowing examinations. Statistical comparisons were used by repeated measures analysis of variance. Significance level was set at P < .05. RESULTS: ILC was significantly longer in stroke survivors with a subcortical lesion than in those with a cortical lesion for both bolus consistencies. However, there were no significant differences between the 2 groups in LCD. Stroke survivors with a subcortical lesion had a greater incidence of penetration or aspiration and silent aspiration than those with a cortical lesion and a longer delay in the ILC. CONCLUSIONS: Subcortical lesions may put these survivors at greater risk of aspiration due to delayed initial laryngeal closure and reduced oral and laryngeal sensation. The subcortical damage, which occurs at the basal ganglia, may interrupt the ILC.


Assuntos
Infarto Cerebral/complicações , Transtornos de Deglutição/etiologia , Deglutição , Laringe/fisiopatologia , Aspiração Respiratória de Conteúdos Gástricos/etiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Infarto Cerebral/diagnóstico por imagem , Infarto Cerebral/fisiopatologia , Transtornos de Deglutição/diagnóstico , Transtornos de Deglutição/fisiopatologia , Feminino , Fluoroscopia , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Aspiração Respiratória de Conteúdos Gástricos/diagnóstico , Aspiração Respiratória de Conteúdos Gástricos/fisiopatologia , Fatores de Risco , Fatores de Tempo , Gravação em Vídeo
19.
Transplant Proc ; 49(4): 886-889, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-28457418

RESUMO

BACKGROUND: Gastro-esophageal reflux disease (GERD) and broncho-aspiration (BA) are known to increase the risk for chronic lung allograft dysfunction (CLAD). However, specific lung injury mechanisms are not clearly known. The objective of the study was to describe histopathological findings in surveillance lung transbronchial biopsies that can be correlated with episodes of BA in the lung allograft. METHODS: This retrospective analysis of surveillance transbronchial biopsies was performed in lung transplant recipients, with available data of broncho-alveolar fluid (cultures and cytology), lung function parameters, and esophageal functional tests. RESULTS: Were analyzed 11 patients, divided into 3 groups: (1) GERD group: 4 patients with GERD and CLAD diagnosis; (2) control group: 2 patients without GERD or CLAD; and (3) BA group: 5 patients with foreign material in lung biopsies. A histopathological pattern of neutrophilic bronchitis (NB) was present in 4 of 4 cases in the GERD group and in 1 of 5 cases in the BA group in 2 or more biopsy samples; culture samples were all negative; the 5 NB-positive patients developed CLAD and died (3/5) or needed re-transplantation (2/5). The other 3 patients in the BA group had GERD without NB or CLAD. Both patients in the control group had transient NB in biopsies with positive cultures but remained free of CLAD. CONCLUSIONS: Surveillance transbronchial biopsies may provide useful information other than the evaluation of acute cellular rejection and can help to identify high-risk patients for allograft dysfunction related to gastro-esophageal reflux.


Assuntos
Refluxo Gastroesofágico/patologia , Transplante de Pulmão/efeitos adversos , Complicações Pós-Operatórias/patologia , Aspiração Respiratória de Conteúdos Gástricos/patologia , Adulto , Biópsia , Brasil , Feminino , Refluxo Gastroesofágico/etiologia , Humanos , Pulmão/patologia , Pulmão/fisiopatologia , Transplante de Pulmão/métodos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Aspiração Respiratória de Conteúdos Gástricos/etiologia , Estudos Retrospectivos , Transplante Homólogo , Transplantes/fisiopatologia
20.
Cerebrovasc Dis Extra ; 7(1): 44-50, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28259883

RESUMO

BACKGROUND: Dysphagia is one of the most dangerous symptoms of acute stroke. Various screening tools have been suggested for the early detection of this condition. In spite of conflicting results, measurement of oxygen saturation (SpO2) during clinical swallowing assessment is still recommended by different national guidelines as a screening tool with a decline in SpO2 ≥2% usually being regarded as a marker of aspiration. This paper assesses the sensitivity of SpO2 measurements for the evaluation of aspiration risk in acute stroke patients. METHODS: Fifty acute stroke patients with moderate to severe dysphagia were included in this study. In all patients, fiberoptic endoscopic evaluation of swallowing (FEES) was performed according to a standardised protocol. Blinded to the results of FEES, SpO2 was monitored simultaneously. The degree of desaturation during/after swallows with aspiration was compared to the degree of desaturation during/after swallows without aspiration in a swallow-to-swallow analysis of each patient. To minimise potential confounders, every patient served as their control. RESULTS: In each subject, a swallow with and a swallow without aspiration were analysed. Overall, aspiration seen in FEES was related to a minor decline in SpO2 (mean SpO2 without aspiration 95.54 ± 2.7% vs. mean SpO2 with aspiration 95.28 ± 2.7%). However, a significant desaturation ≥2% occurred only in 5 patients during/after aspiration. There was no correlation between aspiration/dysphagia severity or the amount of aspirated material and SpO2 levels. CONCLUSIONS: According to this study, measurement of oxygen desaturation is not a suitable screening tool for the detection of aspiration in stroke patients.


Assuntos
Monitorização Transcutânea dos Gases Sanguíneos , Transtornos de Deglutição/diagnóstico , Deglutição , Oxigênio/sangue , Aspiração Respiratória de Conteúdos Gástricos/etiologia , Acidente Vascular Cerebral/complicações , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Transtornos de Deglutição/sangue , Transtornos de Deglutição/etiologia , Transtornos de Deglutição/fisiopatologia , Feminino , Tecnologia de Fibra Óptica , Humanos , Laringoscopia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Aspiração Respiratória de Conteúdos Gástricos/diagnóstico , Aspiração Respiratória de Conteúdos Gástricos/fisiopatologia , Medição de Risco , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/fisiopatologia
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