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Introduction: The efficacy of sugammadex on postoperative pulmonary complications (PPCs) in susceptible patients, compared with neostigmine, remains indeterminate. The Assess Respiratory Risk in Surgical Patients in Catalonia (ARISCAT) Group Investigators proposed a risk index for the early identification of susceptible patients, with excellent externally validated discrimination ability. Meta-analytical techniques were applied to evaluate the efficacy of sugammadex on PPCs in patients with ARISCAT-defined risk factors. Methods: The study is registered on PROSPERO, number CRD42021261156. We searched PubMed, Scopus, Embase, Cochrane library, GreyNet, and OpenGrey for eligible randomized controlled trials (RCTs) without restricting the language or year of publication. Results: Twelve RCTs consisting of 1182 patients susceptible to PPCs were included. A robust reduction was observed on the incidence of PPCs in susceptible patients who received sugammadex [RR 0.66; 95% CI (0.54, 0.80), p < 0.01], with a low level of between-study heterogeneity (I2 = 45.98%; H2 = 1.85). Similar protective effects were also proved in avoiding residual neuromuscular block (NMB) [RR 0.25; 95% CI (0.11, 0.56); p < 0.01], atelectasis [RR 0.74; 95% CI (0.59, 0.95); p = 0.02], pneumonia [RR 0.49; 95% CI (0.28, 0.88); p = 0.02], and respiratory failure [RR 0.61; 95% CI (0.39, 0.96); p = 0.03]. No difference was observed regarding adverse events [RR 0.85; 95% CI (0.72, 1.01); p = 0.06]. Conclusion: Low to moderate quality of evidence demonstrated the edge of sugammadex over neostigmine for NMB reversal in reducing the likelihood of PPCs and residual NMB in patients with ARISCAT-defined risk factors. Clinicians may reassess the type of reversal agent when treating patients susceptible to PPCs. [ABSTRACT FROM AUTHOR]

Background: Patients with aspiration pneumonitis often receive empiric antibiotic therapy despite it being due to a non-infectious, inflammatory response. Objective: To study the benefits of early antibiotic therapy in patients with suspected aspiration pneumonitis in an acute care hospital. Design: Retrospective cohort study using electronic medical records from Teine Keijinkai Hospital. Participants: Adults aged over 18 years admitted with a diagnosis of aspiration pneumonitis to the Department of General Internal Medicine or Emergency Department between January 1, 2008, and May 31, 2019. A diagnosis of aspiration pneumonitis was defined as a documented macro-aspiration event and a chest radiograph demonstrating new radiographic infiltrates. Main measures: Patients were classified into the "early antibiotic treatment" group and the "no or late treatment" group depending on whether they received antibiotic therapy for respiratory bacterial pathogens within 8 h of arrival. The primary outcome was in-hospital all-cause mortality. Secondary outcomes included length of hospital stay, antibiotic-free days, duration of fever, readmission within one month, and incidence of complications. Key results: Of the 146 patients enrolled, 52 (35.6%) did not receive early antibiotic therapy, while the remaining 94 (64.4%) did. There was no difference in in-hospital mortality rates between the groups after adjustment for potential confounding variables using Cox proportional hazards analysis (hazard ratio 2.78; 95% confidence interval, 0.57–13.50, p = 0.20). Patients in the no or late treatment group had more antibiotic-free days (p < 0.001) and a shorter length of hospital stay among survivors (p = 0.040) than did those in the early antibiotic treatment group. There were no statistically significant differences between the groups with respect to other secondary outcomes. Conclusions: Early antibiotic therapy for acute aspiration pneumonitis was not associated with in-hospital mortality, but was associated with a longer hospital stay and prolonged use of antibiotics. [ABSTRACT FROM AUTHOR]

Objectives: Hydrocarbons are a common cause of accidental poisoning in children, with kerosene being the most implicated agent in rural parts of India. However, lately, liquid mosquito repellent ingestion is emerging as an important cause of hydrocarbon (kerosene) poisoning in urban households.Methods: This is a retrospective case series over a 5-y period (January 2013 - December 2017) of children with accidental liquid mosquito repellent ingestion presenting to the pediatric emergency. Epidemiology, clinical profile, management and outcomes are discussed.Results: Twenty-three children with median (IQR) age of 24 (18.8-32) mo presented after mean (SD) interval of 6 (3) h from ingestion. Majority (20, 87%) were seen during summer months (March-June) and all were from urban background. Sixteen (70%) had mild-moderate acute respiratory distress syndrome (ARDS) requiring supplemental oxygen with or without positive airway pressure for a mean (SD) duration of 3.3 (1.9) d. All except one survived.Conclusions: Children with accidental liquid mosquito repellent ingestion had predominant aspiration pneumonitis due to hydrocarbon content rather than neurological complications attributable to synthetic pyrethroids. Ensuring child-proof containers, appropriate storage, regulatory surveillance and parental awareness are must for prevention. [ABSTRACT FROM AUTHOR]

Aspiration pneumonitis refers to acute chemical lung injury caused by aspiration of sterile gastric contents. The aim of this study was to evaluate the role of quercetin (QC) in acid aspiration-induced lung injury in rats. Twenty-eight female Sprague-Dawley rats were used and divided into the following groups ( n = 7): sham (aspirated normal saline, S), hydrochloric acid (aspirated HCl), S plus treatment with QC (S + QC), and HCl plus treatment with QC (HCl + QC). After aspiration, the treatment groups received QC 60 mg/kg/day intraperitoneally once a day for 7 days. As a result of acid aspiration, an increase was observed in the levels of serum clara cell protein-16 (CC-16) and advanced oxidation protein products, whereas there was a decrease in serum thiobarbituric acid-reactive substances, superoxide dismutase (SOD), and catalase levels. There was a significant decrease in peribronchial inflammatory cell infiltration, alveolar septal infiltration, alveolar edema, and alveolar exudate scores, except in the alveolar histiocytes in the HCl + QC group. The expression of nitric oxide synthase, which increased after aspiration in the HCl group, showed a statistically significant decrease after the QC treatment. After the treatment with QC, an increase in the serum SOD level was observed, whereas a significant decrease was determined in the serum CC-16 level relative to that of the aspiration group (HCl). The antioxidant QC is effective in the treatment of lung injury following acid aspiration and can be used as a serum CC-16 biomarker in predicting the severity of oxidative lung injury. [ABSTRACT FROM AUTHOR]

To test the effects of high-frequency percussive ventilation (HFPV) compared with high-frequency oscillatory ventilation (HFOV) and low-volume conventional mechanical ventilation (LVCMV), on lung injury course in a gastric juice aspiration model. Prospective, randomized, controlled, in-vivo animal study. University animal research laboratory. Forty-three New Zealand rabbits. Lung injury was induced by intratracheal instillation of human gastric juice in order to achieve profound hypoxaemia (PaO2/FIO2 ≤ 50). Animals were ventilated for 4 h after randomization in one of the following four groups: HFPV (median pressure 15 cmH2O); LVCMV (VT 6 ml kg–1 and PEEP set to reach 15 cmH2O plateau pressure); HFOV (mean pressure 15 cmH2O); and a high-volume control group HVCMV (VT 12 ml kg–1 and ZEEP). Static respiratory compliance increased after the ventilation period in the HFPV, LVMCV and HFOV groups, in contrast with the HVCMV group. PaO2/FIO2 improved similarly in the HFPV, LVCMV and HFOV groups, and remained lower in the HVCMV group than in the three others. Lung oedema, myeloperoxidase and histological lung injury score were higher in the HVCMV group, but not different among all others. Arterial lactate markedly increased after 4 h of ventilation in the HVCMV group, while lower but similar levels were observed in the three other groups. HFPV, like HFOV and protective CMV, improves respiratory mechanics and oxygenation, and attenuates lung damage. The HFPV provides attractive lung protection, but further studies should confirm these results before introducing HFPV into the clinical arena. [ABSTRACT FROM AUTHOR]

Objective: To characterize hemodynamic changes during experimental aspiration pneumonitis, paying special attention to echocardiographic assessment.Design and Setting: Animal study in a university-based research laboratory.Subjects: Fourteen mechanically ventilated New Zealand white rabbitsInterventions: We instilled 1 ml/kg human gastric juice (mean pH: 4.1+0.2) intratracheally. Hemodynamic and respiratory parameters were measured every hour for 4 h, associated with a transthoracic echocardiography.Measurements and Results: Lung injury occurred within 1 hour with a marked decrease in PaO(2)/FIO(2) and an increase in plateau pressure; after this initial drop the ratio remained stable throughout the experiment. Seven rabbits experienced only a mild to moderate alteration in lung oxygenation function as defined by a PaO(2)/FIO(2) ratio above 200 (group A), while the other seven developed a severe alteration with a ratio below 200 (group B). At the end of the experiment pH and cardiac output were lower in group B than in group A. Using a PaO(2)/FIO(2) threshold value of 150, pH, mean arterial pressure, and cardiac output were lower in the animals with the more severe hypoxemia. Neither left nor right ventricular dysfunction occurred during the experiment, and no animal experienced circulatory failureConclusion: Experimental aspiration pneumonitis after intratracheal infusion of human gastric juice is characterized by a stable fall in PaO(2)/FIO(2). Animals with the most severe lung injury experienced a lower systemic arterial pressure, cardiac output, and metabolic acidosis without circulatory failure or cardiac dysfunction. [ABSTRACT FROM AUTHOR]

Objective: Pulmonary aspiration is a significant cause of admission to the ITU and is associated with significant morbidity and mortality. Aspiration in the supine position produces posterior collapse/consolidation, similar to that seen in ALI/ARDS patients. Prone positioning has been shown to improve oxygenation in ALI/ARDS, but no studies have been performed on pulmonary aspiration.Design: A prospective crossover study.Setting: Twelve-bed ITU.Patients and Participants: Eleven patients admitted to ITU with respiratory failure secondary to witnessed pulmonary aspiration requiring ventilation and an FIO(2) >0.50 after 12 h.Interventions: Patients were placed in a prone position for 8 h and then turned supine for 8 h. Prone positioning was repeated if the FIO(2) remained >0.50. Ventilator settings were not altered in the study period.Measurements and Results: Arterial blood gas analysis was performed every 2 h. The PaO(2)/FIO(2) gradient was calculated. Oxygenation improved on turning prone, with a significant increase in the PaO(2)/FIO(2) ratio ( P<0.01). There was a fall in this gradient on return to the supine position. There was a significant improvement in oxygenation on turning prone for the second period ( P<0.01). Overall, there was a significant improvement in the PaO(2)/FIO(2) ratio in the final supine position when compared to the first ( P<0.05).Conclusion: This study demonstrates a significant improvement in oxygenation in the prone position in pulmonary aspiration. Early prone positioning in patients with pulmonary aspiration requiring ventilation may improve oxygenation by altering V/Q relationships similarly to ARDS, but also may aid drainage of secretions, opening up alveoli and preventing progression to established pneumonitis. [ABSTRACT FROM AUTHOR]

The pulmonary status of six patients was examined between five and seventeen months after they had been treated for aspiration pneumonitis. Patients with pre-existing lung and heart diseases were not included in this study. The evaluation based on clinical and radiological examinations, and on the results of pulmonary function tests, revealed a complete recovery in four patients. In two patients subnormal static lung volumes were the only abnormal findings, pointing to a slight though radiologically invisible pulmonary fibrosis as residual lung damage. However, during exercise arterial blood gases were normal in all patients. These results suggest that in patients without pre-existing lung disease aspiration pneumonitis is associated with a favorable prognosis once the patient has survived the acute phase of the disease. [ABSTRACT FROM AUTHOR]

A case of aspiration pneumonitis during Caesarean section is described. The patient was treated with high-level continuous positive airway pressure (CPAP) resulting in marked improvement and discharge from the Intensive Care Unit 44 hours after the aspiration had occurred. [ABSTRACT FROM AUTHOR]