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Acute respiratory distress syndrome (ARDS) is an uncommon condition in pregnant patients. The causes of ARDS are associated with obstetric causes such as amniotic fluid embolism, preeclampsia, septic abortion, and retained products of conception or nonobstetric causes that include sepsis, aspiration pneumonitis, influenza pneumonia, blood transfusions, and trauma. An essential component in management of ARDS involves good communication between the obstetrics team and critical care specialist and a fundamental understanding of mechanical ventilatory support. Medical therapies such as nitric oxide and corticosteroids play a complimentary role. Extracorporeal life support is beneficial in the management of the parturient with severe ARDS.

Introduction: Incidence of kerosene/ diesel aspiration is rarely reported in adults. Therefore presentation of patients with kerosene/ diesel aspiration pneumonitis at hospital is not well known. Aims: To study clinical profile of patients presenting with pleuritic chest pain following kerosene/diesel aspiration and to evaluate the degree of parenchyma and pleura involvement. We present here data of 20 patients with pleuritic chest pain who informed of aspiration of kerosene/diesel during detailed medical history. Methods: Patients presenting with pleuritic pain were evaluated further to understand suspected kerosene poisoning and were treated accordingly. Sputum was sent for culture. Chest X-rays done on hospital admission and at the end of 1 and 3 weeks. Results: Out of 196 patients presenting with pleuritic chest pain during 2005-2015, 20 patients had history of aspiration of kerosene/diesel 2-3 days prior during siphoning. Examination revealed 12 (60%) patients had pleural rub, 11 (55%) pts had fever. Chest X-Ray demonstrated pneumonitis in 18 (90%). Sputum examination revealed presence of Gram positive cocci. All patients were treated with Cefotaxim (IV) at 1g/ 8 hourly, analgesics and hydration was maintained.15 (75%) patients showed clinical improvements on 7-10 days. Remaining 5 (25%) pts improved in 3 weeks. Radiological improvement was seen in 65% by 3 Weeks and 100 % by 6 weeks. No sequelae were observed by 6 and 9 months. Conclusion: Patients who present with pleuritic chest pain after 2-3 days of exposure should be suspected as kerosene aspiration pneumonitis and should therefore be considered in differential diagnosis of pleuritic chest pain in rural set up.

Objective: We provided continuous training targeting the oral cavity and neck region to elderly, bedridden recipients of non-oral nutrition in addition to conventional physical interventions, with the aim of investigating changes in feeding and swallowing function. Method: Bedridden (and caregiver’s extensive care-requiring), non-tracheotomized patients with a conscious level of 1 or 2 on the Japan Coma Scale (three inclusion criteria) were eligible. We enrolled 13 patients (5 men, 8 women; mean age: 85.2 ± 6.4 years) meeting the three criteria specified in the Setting, who had been receiving nutrition nasogastrically, via a gastrostomy tube, or by central venous hyperalimentation. Intervention was provided three times weekly, as additional interventions to conventional physical function training. The interventions were 1) neck stretching, 2) facilitation of swallowing response, 3) stimulation of the oral cavity, and 4) positioning into an anti-gravity posture (in a position with the back elevated 60° from the bed). Comparative assessments covered 1) intraoral saliva volume, 2) swallowing response time, 3) neck muscle hardness, 4) lip opening width, and 5) aspiration pneumonitis status at the initiation of training and the completion of training three months later. Results: All assessments showed significant changes in a beneficial direction post-training relative to pretraining. Additionally, no participant experienced recurrent aspiration pneumonitis. Conclusion: Selection of suitable training for the target function site, and continuous implementation of that training, are important for achieving efficacy.

Perioperative complications of prolonged surgery and prone positioning are well known. Changing the position from prone to supine in an anesthetized patient can result in aspiration and airway obstruction. The drop-in oxygen saturation and hemodynamic changes are warning signs and can cause acute cardiac decompensation leading to diagnostic dilemma. We present a case where the patient had these changes after changing the position after spine surgery in prone position. A quick response from the treating anesthesiologist and active involvement of cardiologist helped in reaching the diagnosis and successful management of aspiration pneumonitis in this patient. We conclude that a quick response in investigations and multimodality approach helps in the management of such perioperative complications.

Background: In resource-poor setting, identification of predictors of death is of paramount importance for clinicians, so that specific therapies and management strategies can be applied to patients at high risk of dying. This study aims to determine the factors associated with death and predictors of in-patient mortality for stroke among a cohort of stroke patients in two tertiary centers in Northwestern Nigeria. Materials and Methods: This was a prospective study of consecutive patients with acute stroke who were admitted to tertiary hospitals in northwestern Nigeria. A single observer, using pre-defined diagnostic criteria, recorded the information of interest including length of stay, outcome (dead or alive all through 30 days), time of death. Result: A total of 273 patients comprising 179 male and 94 female stroke patients were recruited. One hundred and seventy-four (63.7%) had infarctive stroke while 99 (36.3%) had hemorrhagic stroke (91 intracerebral and 8 sub-arachnoid hemorrhage). One-month mortality was 37%, and the majority was patients with hemorrhagic stroke (69.6%). About two-third (74.5%) of the mortalities occurred during the first week of the event. Logistic regression showed that severe systolic blood pressure, severe diastolic pressure, second or more episode of stroke, severe GCS, seizures, abnormal pupillary size, hemorrhagic stroke type, presence of aspiration pneumonitis, RBS > 200 mg/dl were independent predictors of mortality in stroke. Conclusion: The present study provides information on factors associated with death in stroke. GCS < 8, seizures, abnormal pupillary size, hemorrhagic stroke, aspiration pneumonitis were independent predictors of mortality.

Interest in high-dose baclofen treatment for alcohol dependence has increased over the past few years. In the meantime, the rate of acute baclofen poisoning has increased and life-threatening cases have been reported. Thus, severity of acute poisoning could lessen the benefit of baclofen treatment. Our aim was to evaluate the severity of acute baclofen poisoning independently of confounders and to assess whether severity is correlated with the reported ingested dose. We prospectively included consecutive patients with acute and deliberate baclofen overdose and compared them with gender and age-matched patients from a retrospective cohort of common acute medicine self-poisoning. The primary end-point was the adjusted risk ratio of mechanical ventilation. We also analysed the lengths of mechanical ventilation and risks of aspiration pneumonitis and convulsions. We finally examined the correlation between the supposed reported ingested dose and the severity of poisoning. Fourteen baclofen-poisoned patients were included and matched to 56 poisoned patients. Median age was 45 y/o (40-58), and men comprised 43% of patients. In logistic regression, the adjusted risk ratio of mechanical ventilation was 7.9 (1.4-43.5; p=0.02) for baclofen-treated patients. Aspiration pneumonitis was more frequent in baclofen-treated patients (29% versus 2%; p=0.005), and the length of mechanical ventilation was significantly correlated with the reported ingested dose of baclofen (Spearman coefficients: 0.48; p

Guvenc, Tolga/0000-0003-1468-3415 WOS: 000332484300008 PubMed: 24122261 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.

Background Granulocyte colony-stimulating factor (G-CSF)-producing esophageal squamous cell carcinoma (ESCC) has been considered to have a poor prognosis. We successfully treated a case of G-CSF-producing ESCC in a 92-year-old woman. Case presentation A 92-year-old woman was admitted to our hospital with the complaints of choking while swallowing and dysphagia. Esophagogastroduodenoscopy and contrast-enhanced computed tomography revealed a type 2 esophageal cancer located 26–35 cm from the dental arch, with no distant metastasis. The patient was diagnosed with G-CSF-producing ESCC based on remarkable leukocytosis and high G-CSF levels. The patient underwent radical subtotal esophagectomy. Subsequently, the level of neutrophils (from 23,500/μL to 5000/μL) and the level of G-CSF (from 131 to

Aspiration pneumonitis is a common problem occurring in many clinical disorders. Pumpkin seed oil (PO) is a rich source of antioxidants. This work aimed to assess the effect of PO on the lung histopathological changes induced by acid aspiration. Forty male albino rats assigned to four groups were used. Rats of control group were instilled intratracheally with normal saline 2mL/kg. HCL group instilled with 2mL/kg of HCL 0.1N, pH 1.25. PO group received pumpkin seed oil (PO) orally (∼1375mg/kgbw/day) for 7days. HCL+PO group instilled with 2mL/kg of HCL 0.1N, pH 1.25 and received PO at the same dose of PO group. Lung tissue samples were processed for light, electron microscopic and immunohistochemical study using anti inducible NO synthase (iNOS). The lung of HCL group demonstrated thickened interalveolar septa, inflammatory cell infiltration and significant increase in the area percent of collagenous fibers and immune expression of iNOS. Ultra structurally, disrupted alveolocapillay membrane, degenerated type II pneumocytes and plentiful alveolar macrophages were evident. PO administration partially attenuated these histological and ultra structural alterations and reduced iNOS immune-expression in lung tissue. In conclusion, PO has a protective effect against HCL aspiration lung injury most probably through its antioxidant activity.

The procedures described below are for producing gastric aspiration pneumonitis in mice with alterations for rats and rabbits described parenthetically. We use 4 different injury vehicles delivered intratracheally to investigate the inflammatory responses to gastric aspiration: Normal saline (NS) as the injury vehicle control NS + HCl, pH = 1.25 (acid) NS + gastric particles, pH ≈ 5.3 (part.) NS + gastric particles + HCl, pH = 1.25 (acid + part.) The volume, pH, and gastric particle concentration all affect the resulting lung injury. In mice, we generally use an injury volume of 3.6 ml/kg (rat: 1.2 ml/kg, rabbit: 2.4 ml/kg), an injury pH (for the acid-containing vehicles) of 1.25, and a gastric particulate concentration (in the particulate-containing vehicles) of 10 mg/ml (rat: 40 mg/ml). In our hands this results in a maximal, non-lethal lung injury with ≤ 10% mortality for the most injurious vehicle (i.e., acid + part.) The maximum tolerable particulate concentration needs to be determined empirically for any new strains to be used, especially in genetically-altered mice, because an altered inflammatory response may have detrimental affects on mortality. We have extensive experience utilizing these procedures in the outbred strain, CD-1, as well as many genetically-altered inbred stains on the C57BL/6 background. Choice of strain should be carefully considered, especially in terms of strain-specific immune bias, to assure proper data interpretation. The size of the mouse should be ≥ 20 g at the time of injury. Smaller mice can be attempted, if necessary, but the surgical manipulation becomes increasingly more difficult and the surgery survival rate decreases substantially. There are no size or strain constraints for rat and rabbit models, but we generally use Long-Evans rats at 250–300 g and New Zealand White rats at ≈ 2 kg at the time of initial injury.

Spontaneous cerebrospinal fluid (CSF) rhinorrhea due to a skull base defect requires prompt diagnosis and treatment. Multiple surgical options are available for repairing the fistula, including the two-layer “fascial apposition” method and use of a pedicled nasal-septal flap. A 44-year-old obese woman presented with 4 months of progressive cough, exertional dyspnea, hoarseness, and intermittent fluid drainage from the right nostril. Chest computed tomography (CT) imaging and bronchoscopy showed chronic pneumonitis, which was confirmed by pulmonary wedge resection. CT and magnetic resonance imaging of the skull base, as well as laboratory analysis of the nasal fluid for β2-transferrin, confirmed a skull base defect causing CSF rhinorrhea. During surgery, insertion of a lumbar drain with the intrathecal fluorescein administration was performed, followed by endoscopic endonasal repair using an autologous fascial apposition graft and pedicled nasal-septal flap. Both the CSF leak and the pulmonary complications resolved following the operation with no symptoms at 11-month follow-up. This is the first reported case of spontaneous CSF rhinorrhea complicated by chronic aspiration and pneumonitis. Increased diagnostic complexity due to chronic pulmonary complications resulted in unnecessary interventions and treatment delays. Prompt recognition of spontaneous CSF leaks is essential to prevent potentially harmful complications.

Objective: To investigate the aspiration risk and the aspiration cognition of elderly inpatients. Method: A self-designed questionnaire about the aspiration risk and the aspiration cognition was applied to survey the hospitalized elderly. Result: The aspiration risk of the elderly was higher, up to 41.3%, characterized by coming up with various symptoms. The illnesses the elderly suffering from, types of medication, motion ability and the state of consciousness were the risk factors resulting in aspiration ( P

Patients undergoing abdominal surgery are at risk of developing postoperative respiratory failure (PRF) and postoperative pulmonary complications (PPCs), including hypoxemia, atelectasis, bronchospasm, pleural effusions, aspiration pneumonitis, sputum plugging, lobar collapse, pneumonia, and the requirement for mechanical ventilation (MV). The incidences of PRF and PPCs are 0.2–3.4 and 7.2–40 %, respectively, following elective abdominal surgery, with even higher rates following emergency surgery and in patients older than 80 years [1]. Depending on patient characteristics and demographics, associated mortality can exceed 25 %, with substantial associated increases in health-care costs [1–3].

OBJECTIVES: Some patients with deliberate drug poisoning subsequently have an adverse clinical course. The present study aimed to examine whether the type of drugs ingested and psychiatric diagnoses were related to an adverse clinical course. METHODS: We conducted a cohort study of patients with deliberate drug poisoning admitted to the intensive care unit of a university hospital located in Tokyo, Japan, between September 2006 and June 2013. Intensive care unit (ICU) stay of ≥4 days was used as a primary outcome measure, while the incidence of aspiration pneumonitis was used as a secondary outcome measure. Ingested substances and psychiatric diagnoses were used as explanatory variables. RESULTS: Of the 676 patients with deliberate drug poisoning, 88% had a history of psychiatric treatment and 82% had ingested psychotropic drugs. Chlorpromazine-promethazine-phenobarbital combination drug (Vegetamin®) ranked fifth among the most frequently ingested substances in cases of deliberate drug poisoning and had the highest incidence of prolonged ICU stay (20%) and aspiration pneumonitis (29%). The top three major classes consisted of benzodiazepines (79%), new-generation antidepressants (25%), and barbiturates/non-barbiturates (23%). Barbiturate overdose was independently associated with increased odds of both prolonged ICU stay (8% vs. 17%; odds ratio [OR], 2.97; 95% confidence interval [CI], 1.60-5.55) and aspiration pneumonitis (8% vs. 24%; OR, 3.83; 95% CI, 2.18-6.79) relative to those associated with overdose of only other sedative-hypnotics (i.e., benzodiazepines). CONCLUSION: These results suggest that judicious prescribing of barbiturates by psychiatrists could reduce the risk of an adverse clinical course when a patient attempts an overdose. Language: en

mertoglu, cuma/0000-0003-3497-4092; AVCI, Bahattin/0000-0001-6471-6495 WOS: 000312692600006 PubMed: 23023024 Our aim in this study is to examine the effects of alpha-tocopherol (AT) on rats with aspiration pneumonitis induced with bile acids (BAs). The animals were divided in to four groups, namely saline group (n = 7), saline + AT group (n = 7), BA group (n = 7), and BA + AT group (n = 7). Saline and BA groups aspirated intratracheally with 1 ml/kg saline and 1 ml/kg bile acids, respectively. AT was given at 20 mg/kg/day dosage for 7 days to the groups. AT group was given 20 mg/kg/day AT for 7 days. Malondialdehyde (MDA), Clara cell protein 16 (CC-16), catalase (CAT), superoxide dismutase (SOD), as well as peribronchial inflammatory cell infiltration, alveolar septal infiltration, alveolar edema, alveolar exudate, alveolar histiocytes, and necrosis were evaluated. The CAT activity of the BA group was significantly lower than the saline group. In the BA + AT group, there was a significant increase in SOD and CAT activities when compared with that of the BA group. The CC-16 and MDA contents in the BA group were significantly higher than in the saline group. The CC-16 and MDA levels of the BA + AT group were significantly lower than BA group. Histopathologic changes were seen in BA group, and there was a significant decrease in the BA + AT group. In conclusion, AT might be beneficial in the treatment of aspiration pneumonitis induced by BAs because AT decreased oxidative damage and resulted in a decrease in CC-16 levels.

Opioid analgesia is the primary pharmacologic intervention for managing pain. However, opioids can cause various adverse effects including pruritus, nausea, constipation, and sedation. Respiratory depression is the most fatal side effect. Therefore, cautious monitoring of respiratory status must be done after opioid administration. Here, we report a patient who suffered from respiratory depression with deep sedation and aspiration pneumonitis after intrathecal morphine administration.

The aim of this study was to determine the efficacy of pectin solution, which increases the viscosity of liquid nutrient, for prevention of gastro-esophageal reflux in comparison with half-solid nutrient. The subjects were 10 elderly patients undergoing percutaneous endoscopic gastrostomy feeding. Twenty-four-hour esophageal multichannel intraluminal impedance and pH testing was performed during intake of half-solid nutrient and a combination of pectin solution and liquid nutrient. During 4 h after delivery, there was no significant difference in the total number of gastro-esophageal reflux events between the feeding of the half-solid nutrient and the combination of pectin solution and liquid nutrient (5.7 ± 1.2 vs 5.3 ± 1.0/4 h). Acidic reflux after delivery of the half-solid nutrient was significantly more frequent than that after delivery of the combination of pectin solution and liquid nutrient (80.7% vs 60.4%, p = 0.018). The incidence of gastro-esophageal reflux reaching the upper portion of the esophagus tended to be higher during delivery of the half-solid nutrient than during delivery of the combination of pectin solution and liquid nutrient (47.4% vs 34.0%, p = 0.153). In conclusion, the usage of pectin solution combined with liquid nutrient is effective for preventing acidic gastro-esophageal reflux and gastro-esophageal reflux reaching the upper portion of the esophagus.

Rationale and Objectives Diffraction-enhanced imaging (DEI) is a type of phase contrast x-ray imaging that has improved image contrast at a lower dose than conventional radiography for many imaging applications, but no studies have been done to determine if DEI might be useful for diagnosing lung injury. The goals of this study were to determine if DEI could differentiate between healthy and injured lungs for a rat model of gastric aspiration and to compare diffraction-enhanced images with chest radiographs. Materials and Methods Radiographs and diffraction-enhanced chest images of adult Sprague Dawley rats were obtained before and 4 hours after the aspiration of 0.4 mL/kg of 0.1 mol/L hydrochloric acid. Lung damage was confirmed with histopathology. Results The radiographs and diffraction-enhanced peak images revealed regions of atelectasis in the injured rat lung. The diffraction-enhanced peak images revealed the full extent of the lung with improved clarity relative to the chest radiographs, especially in the portion of the lower lobe that extended behind the diaphragm on the anteroposterior projection. Conclusions For a rat model of gastric acid aspiration, DEI is capable of distinguishing between a healthy and an injured lung and more clearly than radiography reveals the full extent of the lung and the lung damage.

To assess the predictive accuracy of serum procalcitonin in distinguishing bacterial aspiration pneumonia from aspiration pneumonitis.Prospective observational study.Intensive care unit of a university-affiliated hospital.Sixty-five consecutive patients admitted with pulmonary aspiration and seven control subjects intubated for airway protection.None.Quantitative cultures from bronchoalveolar lavage fluid were conducted on all participants at the time of admission. Serial serum procalcitonin levels were measured on day 1 and day 3 using the procalcitonin enzyme-linked fluorescent assay. There were no differences in the median serum concentrations of procalcitonin between patients with positive bronchoalveolar lavage cultures (n = 32) and patients with negative bronchoalveolar lavage cultures (n = 33) on either day 1 or day 3 postadmission. The areas under the receiver operator characteristic curves were 0.59 (95% confidence interval, 0.47-0.72) and 0.63 (95% confidence interval, 0.5-0.75), respectively (p = .74). However, duration of mechanical ventilation and antibiotic therapy were shorter in those who had a decrease in their procalcitonin levels on day 3 from baseline compared with those who did not (6.7 ± 7.1 days and 11.1 ± 13.5 days, p = .03; and 8.2 ± 2.6 days vs. 12.8 ± 4.6 days; p.001, respectively). Hospital mortality was associated with radiographic multilobar disease (adjusted odds ratio, 1.14; 95% confidence interval, 1.01-1.31; p = .04) and increasing procalcitonin levels (adjusted odds ratio, 5.63; 95% confidence interval, 1.56-20.29; p = .008).Serum procalcitonin levels had poor diagnostic value in separating bacterial aspiration pneumonia from aspiration pneumonitis based on quantitative bronchoalveolar lavage culture. However, serial measurements of serum procalcitonin may be helpful in predicting survival from pulmonary aspiration.

Percutaneous endoscopic gastrostomy tube feeding is widely used for patients with swallowing dysfunction and a history of repeated aspiration pneumonitis. However, liquid nutrient feeding via percutaneous endoscopic gastrostomy is not effective enough to prevent aspiration pneumonitis and related inflammatory responses. We performed this prospective multi-centre study to clarify the efficacy of half-solidification of nutrients to prevent fever possibly caused by aspiration pneumonitis in elderly patients with percutaneous endoscopic gastrostomy. The study subjects were 42 elderly patients undergoing percutaneous endoscopic gastrostomy feeding (mean age 85.8 years). All subjects were fed half-solid as well as liquid nutrients for 8 weeks respectively in a cross over design. We counted the number of days with fever caused by pneumonitis and unidentified origin. Thirty-two of 42 patients were successfully observed in both nutrient periods. Fever was frequently observed in both nutrient periods, however, the percentage of observational days with fever during half-solid nutrient feeding was significantly lower than that during liquid nutrient feeding (15.3 ± 0.3 vs 19.8 ± 0.4%, p = 0.030). The percentage of observational days when patients had diarrhea was not significantly different (10.1 ± 3.8 vs 7.2 ± 3.2%, p = 0.357). In conclusion, half-solid nutrient feeding was determined to be effective for reducing fever in patients with percutaneous endoscopic gastrostomy feeding.

Polyethylene glycol (PEG) electrolyte solution, Golytely, is an osmotic laxative commonly used in preoperative bowel cleansing. In this case report, a 9-year-old boy developed aspiration pneumonitis following accidental infusion of PEG solution into his right lung following migration of his nasogastric tube (NGT). Hypoxemia and tachypnea without respiratory failure were observed after infusion. Because PEG is a nonabsorbable toxic material, previous case reports have advocated for the performance of bronchoalveolar lavage (BAL) in the treatment of PEG pneumonitis. With close monitoring, our patient was able to be successfully treated without the need for invasive interventions including BAL or intubation. Generalizations about PEG absorption in the lung based on its permeability in the gastrointestinal tract should not deter the use of more conservative treatment in the appropriate patient.

Recognizing and managing the different types of aspiration events remain a challenging task due to the lack of distinguishing clinical or laboratory characteristics. Numerous biomarkers in serum, sputum and bronchoalveolar lavage have been studied, and their role in the recognition of aspiration remains controversial at this time. Recent animal investigations using an array of biomarkers based on distinct pathogenic features of each aspiration event have produced promising results; however, they have not been validated in humans. Newer markers are being introduced as diagnostic and prognostic tools in conditions such as community-acquired pneumonia and sepsis, but they have not been examined in aspiration. The present review summarizes the different biomarkers that have been studied in aspiration and those who might have a potential clinical use in the future.

Aspiration pneumonia and pneumonitis are common clinical syndromes that occur in hospitalized patients. Aspiration pneumonia occurs in patients with dysphagia and usually presents as a community-acquired pneumonia with a focal infiltrate in a dependent bronchopulmonary segment. Patients with aspiration pneumonia require treatment with broad-spectrum antibiotics and management of the underlying dysphagia. Aspiration pneumonitis follows the aspiration of gastric contents, usually in patients with a marked decreased level of consciousness. Treatment of aspiration pneumonitis is essentially supportive; however, corticosteroids and other immunomodulating agents may have a role in these patients.

Achalasia is one of the most common motility disorders of esophagus characterized by deterioration of the lower esophageal sphincter due to loss of myenteric plexus. The main symptoms are progressive dysphagia towards fluids and solids, regurgitation of food, weight loss, aspiration pneumonitis. Methods such as pneumatic dilatation, pharmacological agents, laparoscopic heller myotomy, and peroral endoscopic myotomy are used in the treatment. We want to present our results of pneumatic dilatation in this study. 31 newly diagnosed patients who underwent pneumatic dilatation at Inonu University Turgut Ozal Medical Center between 2008 and 2016 , were included in the study. Pneumatic dilatation was applied once on 17 (55%) patients, twice on 6 (19%) patients, and thrice and over on 8 (26%) patients. In 27 (87%) patients, success was achieved with pneumatic dilatation and in 4 patients (13%) with laparoscopic Heller myotomy. Pneumatic dilatation being a less invasive method among available treatment methods, still maintains its efficacy when considering low complications and ease of administration. [Med-Science 2018; 7(4.000): 940-2]

Aspiration pneumonia is defined as lung injury caused by the contents of the oral cavity, pharynges, and gaster accidentally entering the airway. It is divided broadly into three categories: chemical injury, aspiration of particulate food matter, and injury by pathogenic bacteria. Aspiration pneumonia during general anesthesia is very rare, occurring in only 0.01-0.03% of cases. The process of lung injury by chemical pneumonitis is divided into two phases: direct chemical injury and secondary inflammation reaction in the lung tissue. In severe cases, excess inflammation reaction in the lung tissue leads to a systemic inflammatory response syndrome and causes acute respiratory distress syndrome. We report a case of aspiration pneumonia of gastric juice occurring upon induction of general anesthesia for orthognathic surgery in a 23-year-old male. Immediate treatment in the intensive care unit resulted in satisfactory progress. We confirmed later that he had an esophageal hiatal hernia. It is important to prevent perioperative complications and consider measures for aspiration pneumonia.

OBJECTIVE. The purpose of this study was to assess CT findings in a series of patients with hydrocarbon pneumonitis after diesel fuel siphonage.CONCLUSION. The characteristic CT findings of hydrocarbon pneumonitis after diesel fuel siphonage are the presence of air–space consolidations with predominant right middle lobe involvement and areas of low attenuation within consolidation. Occasionally, bronchoalveolar lavage is needed to confirm the diagnosis of hydrocarbon pneumonitis by the presence of lipid-laden macrophages on the basis of a history of diesel fuel aspiration.

Background and objective Pulmonary aspiration of gastric acid is a serious complication during anaesthesia and may cause aspiration pneumonitis and adult respiratory distress syndrome. The development of pulmonary hypertension may aggravate the initial course of the aspiration pneumonitis. The authors hypothesized that acid aspiration induces an acute increase in right ventricular pressure in the rat heart. Additionally, it was hypothesized as a secondary study that endothelin levels would be increased in this rat model. Methods Male Sprague Dawley rats, anaesthetized with sevoflurane, underwent tracheostomy, and catheters were inserted into the carotid and right ventricle. Lung injury was induced by instillation of 0.4 ml kg -1 0.1 mol I -1 HCI; a control group received the same volume of 0.9% NaCI. Rats were then ventilated for 6 hours. p a O 2 , mean arterial blood pressures and right ventricular systolic pressures were documented every 30 minutes, and arterial blood gases were measured at baseline, 30, 90, 180, 270 and 360 min. Wet/dry ratio was performed and additionally endothelin-1 levels were examined before and 180 and 360 min after aspiration. Results p a O 2 values were lower, whereas right ventricular systolic pressures were significantly higher in the HCI group. Mortality rate was 50% after HCI aspiration, whereas 100% of the rats survived NaCI aspiration. Wet/dry ratio and endothelin-1 levels showed a significant increase after 180 and 360 min of HCI aspiration. Conclusion Acid aspiration induces a significant increase in right ventricular systolic pressure and endothelin levels, and causes metabolic acidosis in this animal model.

Aspiration pneumonitis and aspiration pneumonia are common entities that occur more frequently in populations that are susceptible to aspiration. In aspiration pneumonitis, the degree of lung injury caused by the aspiration of gastric contents is influenced by the pH and to a lesser extent volume of the aspirate. In aspiration pneumonia, the key precipitating event is the inhalation of colonized oropharyngeal material. While anaerobic bacteria are the classic organisms associated with aspiration pneumonia, gram-negative bacteria also play an important role in its pathogenesis. Although there is enormous potential for the investigation of strategies aiming the prevention of aspiration pneumonia, most studies have failed to show a benefit of these strategies. Recently published clinical trials have evaluated the efficacy of different antibiotic regimens for the treatment of aspiration pneumonia. Importantly, new and simplified antibiotic regimens have emerged as an option for the treatment of aspiration pneumonia.

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/FIO2or =50). Animals were ventilated for 4h after randomization in one of the following four groups: HFPV (median pressure 15cmH2O); LVCMV (VT 6mlkg(-1) and PEEP set to reach 15cmH2O plateau pressure); HFOV (mean pressure 15cmH2O); and a high-volume control group HVCMV (VT 12ml 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 4h 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.

Aspiration syndromes are clinically and pathologically classified into three sets of disorders: (i) large airway mechanical obstruction caused by foreign bodies; (ii) aspiration pneumonitis; and (iii) aspiration pneumonia. In this article, we discuss the common clinical presentations, risk factors, radiographic features and methods of management of these disorders. We highlight recent recommendations and controversies surrounding the prevention of aspiration pneumonia in the critically ill patient. Finally, we review ethical dilemmas surrounding feeding and aspiration risk concerns in debilitated and demented patients.

Background:Aspiration syndromes (pneumonia and pneumonitis) have significantly different processes. An evaluation of treatment and outcomes for these different syndromes has not been reported previously.Objective:To characterize and assess antimicrobial prescribing patterns for aspiration syndromes in intensive care unit (ICU) patients and describe outcomes of those patients.Methods:A retrospective, observational evaluation was conducted using a convenience sample of patients at 27 hospitals in North America; these patients were admitted to an adult ICU with a diagnosis of suspected/confirmed aspiration or had a suspected/confirmed aspiration while in the ICU. Hospital demographic, diagnosis, treatment, and clinical outcome data were collected.Results:Over a 12 month period, 187 patients were observed. Aspiration syndromes included suspected aspiration (31%; n = 58), aspiration pneumonitis (12%; n = 23), aspiration pneumonia (55%; n = 103), and diagnosis not available (1.6%; n = 3). Antimicrobial management for the aspiration syndromes was as follows: suspected aspiration: 59% single agent, 38% multiple agents, and 3% no therapy; aspiration pneumonitis; 48% single agent, 39% multiple agents, and 13% no therapy; aspiration pneumonia: 48% single agent. 52% multiple agents, and 0% no therapy. Antimicrobial therapy was prescribed in patients with suspected (97%) and confirmed (100%) aspiration. Antibiotic therapy duration was significantly longer for aspiration pneumonia (9.1 ± 7.5 days) than for aspiration pneumonitis (5.2 ± 3.6 days; p = 0.013). Length of ICU stay was similar across patient groups.Conclusions:Antimicrobial agents are frequently prescribed to treat aspiration syndromes despite the lack of demonstrated efficacy for aspiration pneumonitis. Outcomes between aspiration syndromes were similar with the exception of duration of antibiotic treatment.

Numerous scientific case reports and observational studies, including that of Curtis Mendelson with its great historical relevance, have reported the problem of aspiration pneumonitis during labour. Because of this, strict fasting prior to delivery to reduce pulmonary aspiration has been doctrine since the 1940s. However, maternal mortality from anaesthesia, particularly from aspiration, has dropped dramatically over recent decades. This is due both to far-reaching improved quality of care as well as technical progress in anaesthesia, which increasingly challenge the scientific basis for fasting in obstetric anaesthesia. Strict fasting has never been proven to reduce morbidity or mortality in labouring women. Because of the physiological and anatomical changes of pregnancy, gastric emptying is theoretically prolonged, and therefore the risk of aspiration is assumed to be increased. However, the available data with patients receiving clear fluids run contrary to this assumption, or at least dispute its clinical relevance. Recent studies report positive influence of reduced fasting time on both maternal comfort and maternal/fetal metabolism without increased risk. This has already led to meaningful discussion regarding a corresponding change in official recommendations.

Background Sleeve gastrectomy (SG) has been linked to increased rates of postoperative gastroesophageal reflux. Objective The aim of this study was to evaluate whether SG is also linked to increased pulmonary extraesophageal reflux disease in a rodent model, based on histologic inflammatory distal airway changes. Setting University hospital. Methods Wistar rats (Charles River Institute, Wilmington, MA) were fed a high fat diet (HFD) for 4 months. They were divided into HFD only (n = 25) and SG+HFD (n = 19) groups and euthanized at 12 weeks, and the trachea and lungs were harvested en bloc then preserved for analysis by a blinded board-certified pathologist. Results Rats who underwent SG were significantly less likely to show postmortem distal airway changes (4.0% versus 31.0%, P = .03), had a lower average chronic aspiration pneumonitis grade (.73 versus 1.57, P = .006), and had a lower total lung injury score (1.19 versus 2.28, P = .005). Alveolar hemorrhage was also less common in the SG+HFD group (37.5% versus 80.0%, P = .006). Conclusion SG is associated with increased incidence of normal lung histology on postmortem examination, less evidence of chronic aspiration pneumonitis and alveolar hemorrhage, and decreased total lung injury score in a rodent model. SG appears to have a protective effect on the pulmonary system. This suggests that SG does not exacerbate extraesophageal reflux effects on the pulmonary epithelium.

We report a case of a 33-year-old woman with depression and suicidal ideation, treated successfully with electroconvulsive therapy (ECT) in the past. Since her previous course of ECT, she underwent gastric banding, a bariatric surgical procedure associated with increased risk of gastric regurgitation. Despite increasingly stringent measures to minimize the risk of regurgitation and aspiration during ECT, she had several episodes of regurgitation, the last of which precipitated an acute illness consistent with aspiration pneumonitis. We took additional precautions after each event, until she had no further episodes of regurgitation. We discuss the risk posed by the gastric band, the measures we implemented to minimize that risk, and our recommendations for assessment and management of post-gastric banding patients who present for ECT.

Aspiration of foreign matter into the airways and lungs can cause a wide spectrum of pulmonary disorders with various presentations. The type of syndrome resulting from aspiration depends on the quantity and nature of the aspirated material, the chronicity, and the host responses. Aspiration is most likely to occur in subjects with a decreased level of consciousness, compromised airway defense mechanisms, dysphagia, gastroesophageal reflux, and recurrent vomiting. These aspiration-related syndromes can be categorized into airway disorders, including vocal cord dysfunction, large airway obstruction with a foreign body, bronchiectasis, bronchoconstriction, and diffuse aspiration bronchiolitis, or parenchymal disorders, including aspiration pneumonitis, aspiration pneumonia, and exogenous lipoid pneumonia. In idiopathic pulmonary fibrosis, aspiration has been implicated in disease progression and acute exacerbation. Aspiration may increase the risk of bronchiolitis obliterans syndrome in patients who have undergone a lung transplant. Accumulating evidence suggests that a causative role for aspiration is often unsuspected in patients presenting with aspiration-related pulmonary diseases; thus, many cases go undiagnosed. Herein, we discuss the broadening spectrum of these pulmonary syndromes with a focus on presenting features and diagnostic aspects.