Seminars in respiratory and critical care medicine
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Aspiration pneumonia (AP) remains a critical health issue, especially among older and hospitalized patients. This review focuses on understanding the epidemiology and pathogenesis of AP, exploring key risk factors, and proposing diagnostic strategies. Aspiration pneumonia is commonly associated with hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP), where pathogens introduced into the lungs from gastric aspiration cause infection. ⋯ It is one of the most common types of pneumonia in older adults, with its prevalence estimated to range from 5% to 24% in cases of CAP admissions. This revision highlights the growing need for comprehensive diagnostic tools and treatment protocols for AP, especially in high-risk populations such as the elderly and those in long-term care. Understanding the underlying mechanisms and the role of silent aspiration can improve prevention strategies and reduce morbidity and mortality in these vulnerable groups.
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Semin Respir Crit Care Med · Dec 2024
ReviewMedications to Modify Aspiration Risk: Those That Add to Risk and Those That May Reduce Risk.
Aspiration pneumonia results from the abnormal entry of fluids into the respiratory tract. We present a review of drugs known to affect the risk of aspiration. Drugs that increase the risk of aspiration pneumonia can be broadly divided into those that affect protective reflexes (like cough and swallowing) due to direct or indirect mechanisms, and drugs that facilitate gastric dysbiosis or affect esophageal and intestinal motility. ⋯ Focusing on modifiable risk factors for aspiration pneumonia is relevant since this may help to reduce the incidence of this often severe problem. Among these, several commonly used drug classes have been shown to increase the risk of aspiration pneumonia. These drugs should be withheld in the high-risk population whenever possible, alongside general measures, such as the semirecumbent position during sleep and feeding.
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Semin Respir Crit Care Med · Dec 2024
ReviewIs There a Role for Bronchoscopy in Aspiration Pneumonia?
Aspiration represents the passage of oropharyngeal content to the lower respiratory tract. The interplay between the host and the aspirate proprieties determines the subsequent aspiration syndrome. A low pH, typical of gastric aspirate, favors chemical pneumonitis, whereas an increased bacterial inoculum causes aspiration pneumonia. ⋯ Invasive microbiological studies increase diagnostic yield and enable a tailored antibiotic treatment. In conjunction with stewardship programs, invasive sampling and novel molecular diagnostics can decrease the amount of inappropriate antibiotic therapy. In the context of foreign body aspiration, bronchoscopy represents both diagnostic and treatment gold standard.
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Semin Respir Crit Care Med · Dec 2024
Review"SWALLOWING AND ASPIRATION: HOW TO EVALUATE AND TREAT SWALLOWING DISORDERS ASSOCIATED WITH ASPIRATION PNEUMONIA IN OLDER PERSONS".
Aspiration pneumonia (AP) is the most severe complication of oropharyngeal dysphagia (OD). It is highly underdiagnosed and undertreated among older patients hospitalized with community-acquired pneumonia (CAP). Our aim is to review the state of the art in the diagnosis and treatment of swallowing disorders associated with AP. ⋯ The diagnosis of AP must be based on standardized criteria providing evidence on the main etiological factor, oropharyngeal aspiration. Clinical algorithms are valid in the diagnosis of AP and the identification of its main risk factors. Combination of AI-based tools with V-VST can lead to massive screening of OD and save resources and improve efficiency in the detection of AP.
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Semin Respir Crit Care Med · Dec 2024
ReviewPrevention of Aspiration: Oral Care, Antibiotics, Others.
Patients with aspiration pneumonia often develop this lung infection due to poor oral health or because the contents of the digestive tract or upper airway enter the lower airway traversing the larynx through different mechanisms. Prevention of this condition is directed at the mechanism by which it occurs. ⋯ People with dysphagia complicated by pneumonia have limited feeding and become debilitated, and aspiration pneumonia in these individuals has a high mortality rate at 90 days. Dietary modifications, assistance with feeding, use of postures that facilitate a normal deglutition, rehabilitation, and use of medications to improve swallowing defects are the tools of medicine to overcome the obstacles to swallowing normally and prevent the development of aspiration pneumonia and its consequences.