Citation Context

...proximately one third of the patients [45,46]. Reviews (2) and primal)' investigations [10,18,44, 47-51] have reported overall mortality rates for AIPI ranging from as high as 85% [50) to as low as 0 =-=[5]-=-. Most reports of high mortality describe patients who were already critically ill or se\'erely debilitated at the time ofaspiration. In addition, "patient selection procedures requiring documentation...

Citation Context

...l flora of hospitalized patients [126] account for the different bacteriologic profile of nosocomial infections, which are more frcquently caused by gram-negative organisms and Stapb)'lococcus oureus =-=[15,78,127]-=-. Although oropharyngcal sccretions may entcr the lung during aspiration ofgastric contcnts, infection rarely results at that time [12,15,441. It may bc that dilution of these bactcria by gastric mate...

Citation Context

...on et ai. (102) found a similar incidence (Il%) of "aspiration pneumonia," defined b}' radiologic and clinical criteria, in 36 patients fed through a percutaneously placed jejunostomy. Kadakia et ai. =-=(103)-=- retrospectively evaluated complications of percutaneous endoscopic gastrostomy and jejunostomy in 79 patients, and found an overall aspiration incidence of 11%. Six patients who underwent jejunostomy...

Citation Context

..., found that "definite or probable aspiration" (not further defined) occurred in 27% of patients with gastrostomy and 38% of those with jejunostomy, again not a significant difference.l\lulIan et al. =-=[52]-=- also found similar rates of aspiration in patients fed by gastrostomy or jejunostomy (or fed nasoenterically). In summary, the disadvantages of nasoenteric feeding, particularly adverse effects on fu...

Citation Context

...in certain patients at increased risk, the protection afforded by the endotracheal tube, even with a modern lowpressure, high-volume cuff, is clearly incomplete [1,56--60]. For example, Elpern et a\. =-=[57]-=- used a dye indicator method to assess aspiration in 31 critically ill, tracheally intubated adults. Twenty-four (77%) patients were found to have aspirated at some time during a 5-day observation per...

Citation Context

...iltrate on chest radiograph, as noted in the patient record," was diagnosed in 6% of patients with gastrostomy and 2% with jejunostomy, a difference without statistical significance. Bergstrom et al. =-=[95]-=-, reviewing the records of 77 patients with surgically placed feeding tubes during a 13-year period, found that "definite or probable aspiration" (not further defined) occurred in 27% of patients with...

Citation Context

...ying acidity established pH values necessary to damage the lungs of various animal species [8,9,17] and suggested that a value ofapproximately 2.5 was critical for inducing pulmonary injury in humans =-=[1,15,18,19]-=-. The results of these experiments led to an analogy between aspiration of gastric contents and a chemical burn to the airway, with direct injury attributable to acid, correlating inversely with pH [1...

Citation Context

...onic fluids, milk, and infant formula [34,35]. Moreover, the relevance of animal experiments involving intratmcheal instillation ofacid as a model of human aspiration has been legitimately questioned =-=[2,36,37]-=-. Measurement of acidity of human aspirates is complicated by dilution, dispersion, and buffering, all of which occur rapidly [6,32,38]. Because of these difficulties, the value of 2.5 commonly cited ...

Citation Context

... three clinical patterns following aspiration: (1) rapid progression to death (12%), typically within 24 hours; (2) rapid clinical and radiographic improvement (62%), usually within several days; and =-=(3)-=- initial stabilization or improvement, followed by deterioration with new or extending radiographic infiltrates (26%), associated with recovel)' of bacterial pathogens (mainly gram-negative bacilli) f...

Citation Context

...he present, however, the mainstay of therapy remains support and close, expectant observation. The primary objcctive of initial management of massive aspiration is to provide and maintain oxygenation =-=[4]-=-. Adequacy of the airway is obviously essential, and may necessitate intubation and/or removal of solid and semisolid material from the upper respiratory tract. Fiberoptic laryngoscopy or bronchoscopy...

Citation Context

...caused widespread inflammatory changes, the se\'erity of which correlated more closely with food type than with actual pH. Filtered samples caused significantly fewer inflammatory changes. Awe et aI. =-=[6]-=-, in 1966, induced "experimental aspiration pneumonitis" in dogs by instilling tube feedings in volumes up to 4 cc/kg. In an important study, Schwartz et aI. [29] instilled into the lungs of dogs HCl ...

Citation Context

... in animals as investigational models [11,20-27]. Additional studies, however, have demonstmted the importance of partially digested food particles in gastric aspirates [6,7,28-30]. In 1952, Teabeaut =-=[7]-=- instilled into the lungs of mbbits filtered and unfiltered human gastric material obtained 1 to 2 hours after ingestion of dairy, meat, vegetable, or alcohol meals. He found that material obtained af...

Citation Context

...7 bits following instillation of hydrochloric acid (HCI). Subsequent investigators using HCI solutions of varying acidity established pH values necessary to damage the lungs of various animal species =-=[8,9,17]-=- and suggested that a value ofapproximately 2.5 was critical for inducing pulmonary injury in humans [1,15,18,19]. The results of these experiments led to an analogy between aspiration of gastric cont...

Citation Context

...7 bits following instillation of hydrochloric acid (HCI). Subsequent investigators using HCI solutions of varying acidity established pH values necessary to damage the lungs of various animal species =-=[8,9,17]-=- and suggested that a value ofapproximately 2.5 was critical for inducing pulmonary injury in humans [1,15,18,19]. The results of these experiments led to an analogy between aspiration of gastric cont...

Citation Context

...rily predict the ability to swallow without aspiration [1,701. DeVita and Spierer-Rundback [701 evaluated swallowing in 11 patients without underlying neurologic disease after prolonged transtracheal =-=(10)-=- or translaryngeal (1) intubation; mean age of the study group was 65 years and duration of intubation was about 20 days. Barium swallow videoflouroscopy demonstrated swallowing abnormalities in all p...

Citation Context

...Gmm'sstained specimen of sputum or bronchial secretions, or an increase in the number of bacteria as compared to specimens examined earlier in the intercurrent illness, might favor antibiotic therapy =-=(12)-=-. The value ofsuch specimens is uncertain, however, and their interpretation must be approached with caution, as has been recommended in general for use of Gmm's-stained specimens in diagnosis of both...

Citation Context

...ying acidity established pH values necessary to damage the lungs of various animal species [8,9,17] and suggested that a value ofapproximately 2.5 was critical for inducing pulmonary injury in humans =-=[1,15,18,19]-=-. The results of these experiments led to an analogy between aspiration of gastric contents and a chemical burn to the airway, with direct injury attributable to acid, correlating inversely with pH [1...

Citation Context

...7 bits following instillation of hydrochloric acid (HCI). Subsequent investigators using HCI solutions of varying acidity established pH values necessary to damage the lungs of various animal species =-=[8,9,17]-=- and suggested that a value ofapproximately 2.5 was critical for inducing pulmonary injury in humans [1,15,18,19]. The results of these experiments led to an analogy between aspiration of gastric cont...

Citation Context

...ying acidity established pH values necessary to damage the lungs of various animal species [8,9,17] and suggested that a value ofapproximately 2.5 was critical for inducing pulmonary injury in humans =-=[1,15,18,19]-=-. The results of these experiments led to an analogy between aspiration of gastric contents and a chemical burn to the airway, with direct injury attributable to acid, correlating inversely with pH [1...

Citation Context

...ying acidity established pH values necessary to damage the lungs of various animal species [8,9,17] and suggested that a value ofapproximately 2.5 was critical for inducing pulmonary injury in humans =-=[1,15,18,19]-=-. The results of these experiments led to an analogy between aspiration of gastric contents and a chemical burn to the airway, with direct injury attributable to acid, correlating inversely with pH [1...

Citation Context

...ve used animal-HCI models [20-28]. These studies have demonstrated that intra-airway instillation of HCl causes lung damage through the induction of a complex inflammatory process involving cytokines =-=[20,24]-=-, proteases [22-25], eicosanoids [23,26,27], reactive oxygen species [22], adhesion molecules [21,26], and activated leukocytes [251. One of the earliest to appear and most important participants in t...

Citation Context

...HCl causes lung damage through the induction of a complex inflammatory process involving cytokines [20,24], proteases [22-25], eicosanoids [23,26,27], reactive oxygen species [22], adhesion molecules =-=[21,26]-=-, and activated leukocytes [251. One of the earliest to appear and most important participants in this process is interleukin-8 OL-8), a potent chemokine attracting neutrophils to extravascular sites ...

Citation Context

...a-airway instillation of HCl causes lung damage through the induction of a complex inflammatory process involving cytokines [20,24], proteases [22-25], eicosanoids [23,26,27], reactive oxygen species =-=[22]-=-, adhesion molecules [21,26], and activated leukocytes [251. One of the earliest to appear and most important participants in this process is interleukin-8 OL-8), a potent chemokine attracting neutrop...

Citation Context

... studies have demonstrated that intra-airway instillation of HCl causes lung damage through the induction of a complex inflammatory process involving cytokines [20,24], proteases [22-25], eicosanoids =-=[23,26,27]-=-, reactive oxygen species [22], adhesion molecules [21,26], and activated leukocytes [251. One of the earliest to appear and most important participants in this process is interleukin-8 OL-8), a poten...

Citation Context

...ve used animal-HCI models [20-28]. These studies have demonstrated that intra-airway instillation of HCl causes lung damage through the induction of a complex inflammatory process involving cytokines =-=[20,24]-=-, proteases [22-25], eicosanoids [23,26,27], reactive oxygen species [22], adhesion molecules [21,26], and activated leukocytes [251. One of the earliest to appear and most important participants in t...

Citation Context

...g injury has been well established. Multiple studies have shown Significant attenuation ofinjury by depletion ofneutrophils or by inhibition of their activation [25,27,42). For example, Knight et al. =-=[25]-=- found that 6 hours after intratracheal instillation of an acidic solution, ah'eolar capillary permeability was decreased in rats made neutropenic by intravenous administration of a selective, polyclo...

Citation Context

... studies have demonstrated that intra-airway instillation of HCl causes lung damage through the induction of a complex inflammatory process involving cytokines [20,24], proteases [22-25], eicosanoids =-=[23,26,27]-=-, reactive oxygen species [22], adhesion molecules [21,26], and activated leukocytes [251. One of the earliest to appear and most important participants in this process is interleukin-8 OL-8), a poten...

Citation Context

... studies have demonstrated that intra-airway instillation of HCl causes lung damage through the induction of a complex inflammatory process involving cytokines [20,24], proteases [22-25], eicosanoids =-=[23,26,27]-=-, reactive oxygen species [22], adhesion molecules [21,26], and activated leukocytes [251. One of the earliest to appear and most important participants in this process is interleukin-8 OL-8), a poten...

Citation Context

...fewer inflammatory changes. Awe et aI. [6], in 1966, induced "experimental aspiration pneumonitis" in dogs by instilling tube feedings in volumes up to 4 cc/kg. In an important study, Schwartz et aI. =-=[29]-=- instilled into the lungs of dogs HCl at a pH of 1.8, human gastric contents containing small food particles titrated to a pH of 1.8 or 5.9, or filtered human gastric contents at a pH of 5.9. Animals ...

Citation Context

... pH of 1.8 or 5.9, or filtered human gastric contents at a pH of 5.9. Animals receiving HCI and unfiltered gastric contents regardless of pH developed significant pneumonitis. Similarly, Wynne et aI. =-=[30]-=- found that instillation of human gastric contents into the lungs of rabbits caused severe pulmonary injury even though the pH of the material was 4.3. In other animal studies, injury independent of p...

Citation Context

...monary injury even though the pH of the material was 4.3. In other animal studies, injury independent of pH has also been associated with instillation of l\1g0H and AIOH with pH values as high as 6.4 =-=[31]-=-, fecally contaminated gastric contents with high bacterial density (pH of 6.4) despite treatment with antibiotics [8,32), increased volumes of aspirate [9,33], hypertonic fluids, milk, and infant for...

Citation Context

...g0H and AIOH with pH values as high as 6.4 [31], fecally contaminated gastric contents with high bacterial density (pH of 6.4) despite treatment with antibiotics [8,32), increased volumes of aspirate =-=[9,33]-=-, hypertonic fluids, milk, and infant formula [34,35]. Moreover, the relevance of animal experiments involving intratmcheal instillation ofacid as a model of human aspiration has been legitimately que...

Citation Context

...ally contaminated gastric contents with high bacterial density (pH of 6.4) despite treatment with antibiotics [8,32), increased volumes of aspirate [9,33], hypertonic fluids, milk, and infant formula =-=[34,35]-=-. Moreover, the relevance of animal experiments involving intratmcheal instillation ofacid as a model of human aspiration has been legitimately questioned [2,36,37]. Measurement of acidity of human as...

Citation Context

...ally contaminated gastric contents with high bacterial density (pH of 6.4) despite treatment with antibiotics [8,32), increased volumes of aspirate [9,33], hypertonic fluids, milk, and infant formula =-=[34,35]-=-. Moreover, the relevance of animal experiments involving intratmcheal instillation ofacid as a model of human aspiration has been legitimately questioned [2,36,37]. Measurement of acidity of human as...

Citation Context

...onic fluids, milk, and infant formula [34,35]. Moreover, the relevance of animal experiments involving intratmcheal instillation ofacid as a model of human aspiration has been legitimately questioned =-=[2,36,37]-=-. Measurement of acidity of human aspirates is complicated by dilution, dispersion, and buffering, all of which occur rapidly [6,32,38]. Because of these difficulties, the value of 2.5 commonly cited ...

Citation Context

...onic fluids, milk, and infant formula [34,35]. Moreover, the relevance of animal experiments involving intratmcheal instillation ofacid as a model of human aspiration has been legitimately questioned =-=[2,36,37]-=-. Measurement of acidity of human aspirates is complicated by dilution, dispersion, and buffering, all of which occur rapidly [6,32,38]. Because of these difficulties, the value of 2.5 commonly cited ...

Citation Context

... as a model of human aspiration has been legitimately questioned [2,36,37]. Measurement of acidity of human aspirates is complicated by dilution, dispersion, and buffering, all of which occur rapidly =-=[6,32,38]-=-. Because of these difficulties, the value of 2.5 commonly cited as a "critical pH" for AIPI in man was extrapolated from animal experiments and never directly established. Even among nonprimate speci...

Citation Context

...tress ulcer prophylaxis [41,131-134] and enteral feeding [121,122], but is also associated with advanced age [135] and more generally with "exocrine organ failure" that characterizes critical illness =-=[39,40]-=-. For example, gastric pH was found to be greater than 5 in approximately 80% of patients with hypovolemia or shock [391. Moreover, impaired or absent gastrointestinal motility is common in leu patien...

Citation Context

...tress ulcer prophylaxis [41,131-134] and enteral feeding [121,122], but is also associated with advanced age [135] and more generally with "exocrine organ failure" that characterizes critical illness =-=[39,40]-=-. For example, gastric pH was found to be greater than 5 in approximately 80% of patients with hypovolemia or shock [391. Moreover, impaired or absent gastrointestinal motility is common in leu patien...

Citation Context

...ecules and ligands that are upregulated by proinflammatory mediators such as TNF-a, IL-l, and leukotriene 13 1 in the setting of lung injury resulting from acid aspiration as well as other etiologies =-=(43)-=-. Goldman et ai. [211 investigated the role of adhesion mole-, cules in experiments in which rabbits were treated intravenously with monoclonal antibodies against CD-18 or ICAl\I-I prior to intrabronc...

Citation Context

...abilizes or even improves after the initial aspiration, but thcn deteriorates with new or expanding radiographic infiltrates, new fever and leukocytosis, and newly pumlent sputum or trachcal aspirate =-=[44]-=-. Unfortunately, even using invasive di-, agnostic tools, it may remain difficult to establish the presence of such an infection or to distinguish infectious from noninfectious injury. While specimens...

Citation Context

...to include subjects who developed acute respiratory distress syndrome. In two prospective studies of patients at high risk, witnessed aspiration led to ARDS in approximately one third of the patients =-=[45,46]-=-. Reviews (2) and primal)' investigations [10,18,44, 47-51] have reported overall mortality rates for AIPI ranging from as high as 85% [50) to as low as 0 [5]. Most reports of high mortality describe ...

Citation Context

...to include subjects who developed acute respiratory distress syndrome. In two prospective studies of patients at high risk, witnessed aspiration led to ARDS in approximately one third of the patients =-=[45,46]-=-. Reviews (2) and primal)' investigations [10,18,44, 47-51] have reported overall mortality rates for AIPI ranging from as high as 85% [50) to as low as 0 [5]. Most reports of high mortality describe ...

Citation Context

...overall mortality in the study population was 17% during the 6-month observation period, there was no excess mortality specifically associated with aspiration. In a \'el)' large study, \Varner et ai. =-=[47]-=- evaluated the perioperative cOllrse of over 172,000 patients undergoing more than 215,000 elective or emergency procedures with general anesthesia at a single hospital over a 6-year period. Only 67 w...

Citation Context

...nts had no significant pulmonal)' sequelae; for example, among 54% of episodes ofaspiration that were radiologically e\'aluated, the chest x-ray was unchanged in almost one third. Hickling and Howard =-=[49]-=- conducted a retrospective study of mortality in 38 patients who developed AIPI in association with a variety of underlying critical illnesses. All patients required intensive care and mechanical vent...

Citation Context

...ion, can result from a variety of coexisting factors including sepsis, advanced age, metabolic derangement, narcotics, diabetes, neuromuscular disease, and enteral tube feeding [39,551. Pick et al.'s =-=[51]-=- prospective study of aspiration in elderly, chronically ill, neurologically debilitated patients used multivariate analysis to assess risk factors. Aspiration was significantly associated with a hist...

Citation Context

...ddition of positive pressure ventilation, apart from its effects on the caliber of the trachea, may also interfere with synchronization of swallowing and breathholding as needed to prevent aspiration =-=[56]-=-. On the other hand, some investigators have observed a greater frequency of aspiration in tracheally intubated patients who ventilate spontaneously, as compared to those who are mechanically ventilat...

Citation Context

...the use of such measures as head-up positioning and cuff inflation. Clinical consequences of aspiration were not evaluated. The artificial airway may actually promote aspiration by severJI mechanisms =-=[57,61,62]-=-. Endotracheal intubation depresses airway sensation and dismpts laryngeal closure and elevation, all known to be important for effective airway protection. The addition of positive pressure ventilati...

Citation Context

...the use of such measures as head-up positioning and cuff inflation. Clinical consequences of aspiration were not evaluated. The artificial airway may actually promote aspiration by severJI mechanisms =-=[57,61,62]-=-. Endotracheal intubation depresses airway sensation and dismpts laryngeal closure and elevation, all known to be important for effective airway protection. The addition of positive pressure ventilati...

Citation Context

...more, although the incidence of tracheal injury has been reduced by the use of high-volume, low-pressure cuffs, the incidence of laryngeal injury, although always lower, has not changed Significantly =-=[63]-=-. .. Transtracheal intubation has been associated with a greater risk for aspiration than translaryngeal intubation [57,61l. In the presence of a tracheostomy, the trachea is anchored both to the stra...

Citation Context

...the use of such measures as head-up positioning and cuff inflation. Clinical consequences of aspiration were not evaluated. The artificial airway may actually promote aspiration by severJI mechanisms =-=[57,61,62]-=-. Endotracheal intubation depresses airway sensation and dismpts laryngeal closure and elevation, all known to be important for effective airway protection. The addition of positive pressure ventilati...

Citation Context

...the presence of a tracheostomy, the trachea is anchored both to the strap muscles and to the skin of the neck, thereby further limiting laryngeal elevation that is required for proper glottic closure =-=[62,64,65]-=- Inflation of the cuff may also cause obstmction of the cervical esophagus in some patients [64-661. In addition, Sasaki et a\. [671 showed in experimental animals that chronic bypass of the upper air...

Citation Context

...ring expimtion with the cuff deflated served to reestablish airflow through the upper airway, but did not reduce aspiration after the occlusion was removed. This maneuver has been suggested by others =-=[67,69]-=- to reduce aspiration by restoring subglottic pressures and improving vocal cord function during swallowing. An increased risk of aspiration continues after extubation [70-74]. This is the case even i...

Citation Context

...or weaning and rehabilitation. In an earlier study in which aspiration was assessed by the presence in the tracheal tube of Evans blue dye that had been placed on the patient's tongue, Cameron et a\. =-=[68]-=- found evidence of aspiration in 42 of 61 (69%) surgical patients who had tracheostomies. By comparison, none of 25 patients with oral endotracheal tubes in this study had a positive dye test. Recentl...

Citation Context

...ring expimtion with the cuff deflated served to reestablish airflow through the upper airway, but did not reduce aspiration after the occlusion was removed. This maneuver has been suggested by others =-=[67,69]-=- to reduce aspiration by restoring subglottic pressures and improving vocal cord function during swallowing. An increased risk of aspiration continues after extubation [70-74]. This is the case even i...

Citation Context

...d of tracheal intubation, and may represent the clinical correlate oflaryngeal and pharygeal damage that has been observed in animals and patients after intubation [75,76]. In an early study, Gardner =-=[72]-=- reported aspiration of radiopaque dye by 10 of 94 patients several days postoperatively. Burgess et a\. [73] subsequently conducted asat PENNSYLVANIA STATE UNIV on February 18, 2016jic.sagepub.comDow...

Citation Context

...been observed in animals and patients after intubation [75,76]. In an early study, Gardner [72] reported aspiration of radiopaque dye by 10 of 94 patients several days postoperatively. Burgess et a\. =-=[73]-=- subsequently conducted asat PENNSYLVANIA STATE UNIV on February 18, 2016jic.sagepub.comDownloaded fromsNelson and Lesser: Aspiration-Induced Pulmonary Injury 285 shorter-term study of 64 alert patien...

Citation Context

... awake and alert after a short period of tracheal intubation, and may represent the clinical correlate oflaryngeal and pharygeal damage that has been observed in animals and patients after intubation =-=[75,76]-=-. In an early study, Gardner [72] reported aspiration of radiopaque dye by 10 of 94 patients several days postoperatively. Burgess et a\. [73] subsequently conducted asat PENNSYLVANIA STATE UNIV on Fe...

Citation Context

...trient solutions through a misplaced tube in the tracheobronchial tree is the equivalent of massive spontaneous aspiration, a catastrophic event that is well known to cause serious morbidity or death =-=[80]-=-. Even when access is properly established in the gastrointestinal tract, however, feeding may still be a factor predisposing to aspiration [1,48,51,52,81-831. Published rates of aspiration in enteral...

Citation Context

...dies have shown that the placement ofa gastrostomy, by either endoscopic or surgical methods, may also alter lower esophageal sphincter physiology in ways that may promote aspiration [88,891. Papaila =-=[88]-=-, for example, found a significant decrease in LES pressures with both surgical and percutaneous endoscopic gastrostomy in cats. Decreased LES pressures were also reported by Jolley et al. [89], who s...

Citation Context

...apaila [88], for example, found a significant decrease in LES pressures with both surgical and percutaneous endoscopic gastrostomy in cats. Decreased LES pressures were also reported by Jolley et al. =-=[89]-=-, who studied pediatric patients with surgical gastrostomies. Thus it is not surprising that aspiration has been well documented after percutaneous endoscopic gastrostomy (PEG) [90,911 or surgical gas...

Citation Context

...ate normal eating patterns, and the continuous protocol may actually promote aspiration by constantly maintaining the stomach in a postprandial state with greater frequency of gastroesophageal reflux =-=[91,120]-=-' In addition, continuous feeding has been associated with elevation of gastric pH, which in turn is associated with bacterial colonization of the stomach, oropharynx, and trachea, and is thought to p...

Citation Context

...died pediatric patients with surgical gastrostomies. Thus it is not surprising that aspiration has been well documented after percutaneous endoscopic gastrostomy (PEG) [90,911 or surgical gastrostomy =-=[92]-=-. In one study [921, more than 60% ofsat PENNSYLVANIA STATE UNIV on February 18, 2016jic.sagepub.comDownloaded froms286 Journal of Intensivc Carc l\ledicine Vol 12 ~o 6 ~ovcmbcr-Dcccmhcr 1997 patients...

Citation Context

...mpared rates of aspiration with nasoenteric feeding versus gastrostomy or jejunostomy (endoscopic or surgical). A nonrandomized prospective study of tube feedings in elderly patients by Ciocon et ai. =-=(93)-=- found no significant difference in aspiration pneumonia between patients fed by nasogastric tube and those fed by gastrostomy or jejunostomy. In the elderly, chronically ill patients studied by Pick ...

Citation Context

...eeding were found by multivariate analysis to be significant risk factors for aspiration; the odds ratio was similar (5.3 for the nasogastric tube and 5.1 for gastrostomy). A retrospective comparison =-=(94)-=- of feeding via PEG or nasoenteric tube showed no significant difference in cumulative frequency of aspiration pneumonia or overall survival during a mean [ollow-up period ofabout 6 months, although m...

Citation Context

...ed to location of enteral feeding was reported in 1990 by L1.zams et ai. [Ill), who reviewed 45 studies describing complications in neurologically impaired patients. Only two studies, one prospective =-=(99)-=- and one retrospective (112), compared risk of aspiration with gastric and jejunal feedings, and these were found to be flawed in many important respects, including lack of randomization or controls [...

Citation Context

...on, whether the distal site is accessed through the nasopharynx (i.e., nasoenteric tube) or through surgical or percutaneous endoscopic feeding tube (jejunostomy) placement. For example, Adams et ai. =-=(101)-=- retrospectively reviewed a 15-year experience with complications of surgically placed jejunostomy. Aspiration (diagnostic criteria not specified) occurred in 12% of patients, including some whose jej...

Citation Context

...some whose jejunostomy was never used after placement. The risk of aspiration was not related to the type of jejunostomy but was strongly related to a previous history of aspiration. Henderson et ai. =-=(102)-=- found a similar incidence (Il%) of "aspiration pneumonia," defined b}' radiologic and clinical criteria, in 36 patients fed through a percutaneously placed jejunostomy. Kadakia et ai. (103) retrospec...

Citation Context

...rsus postpyloric feeding fails to reveal solid evidence supporting a preference for the site of feeding based on aspiration risk. Different sites of nasoenteric feeding were compared by Strong et ai. =-=(109)-=-, who prospectively studied 33 in-patients randomly assigned to receive continuous feedings through small-bore nasoenteric tubes placed either in the stomach or beyond the second portion of the duoden...

Citation Context

...nificant difference was detected between the pre- and postpyloric routes of nasoenteral nutrition. Another prospective and randomized trial of nasoenteric feeding was conducted by l\lontecalvo et ai. =-=(110)-=-, who compared various nutritional parameters as well as rates of nosocomial pneumonia in 38 ICU patients who received feedings through naso- or orogastric tubes or endoscopically placed nasojejunal t...

Citation Context

...eeding was reported in 1990 by L1.zams et ai. [Ill), who reviewed 45 studies describing complications in neurologically impaired patients. Only two studies, one prospective (99) and one retrospective =-=(112)-=-, compared risk of aspiration with gastric and jejunal feedings, and these were found to be flawed in many important respects, including lack of randomization or controls [111). Serious limitations we...

Citation Context

...ding a meaningful meta-analysis of the literature, and leading to the conclusion that no evidence existed to support the preferential usc of jejunal or gastric feeding [111). More recently Fox et ai. =-=(113)-=- conducted a retrospective review to'compare the incidence ofaspiration pneumonia in 155 patients with surgicallysat PENNSYLVANIA STATE UNIV on February 18, 2016jic.sagepub.comDownloaded fromsNelson a...