DOCSLIB.ORG

Pneumonia from Pulmonary Aspiration of an Antihypertensive Anesthetic Premedication −A Case Report−

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Pneumonia from Pulmonary Aspiration of an Antihypertensive Anesthetic Premedication −A Case Report− Anesth Pain Med 2011; 6: 402～405 ￭Case Report￭ Pneumonia from pulmonary aspiration of an antihypertensive anesthetic premedication −A case report− Department of Anesthesiology and Pain Medicine, Inchoen St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea Soo Kyoung Park, and Eun Jung Cho A 75-year-old man was scheduled for a ray amputation of the left an oral preanesthetic medication could lead to aspiration and third metatarsal bone. He had a right middle cerebral artery (MCA) aspiration pneumonia. territory infarction 6 months earlier and had a history of dysphagia and repeated pneumonias. At 06:30 on the day of surgery, nifedi- pine was administered orally with small amounts of water and the CASE REPORT patient coughed several times. Immediately after extubation at the end of anesthesia, an impacted drug-like material was noted in the A 75-year-old man (height, 167 cm; weight, 56 kg) was endotracheal tube. It is likely that aspiration occurred at the time nifedifine was ingested the morning of surgery. The route of admini- scheduled for a ray amputation of the left third metatarsal stration for premedications, should be modified when patients have bone. He had had histories of type 2 diabetes mellitus for 20 perioperative risk factors for pulmonary aspiration. (Anesth Pain years and hypertension for 30 years, which were treated with Med 2011; 6: 402∼405) insulin and a calcium channel blocker. He had a right middle Key Words: Antihypertensive premedication, Cerebral infarction, cerebral artery (MCA) territory infarction 6 months earlier. At General anesthesia, Pulmonary aspiration. the time of admission, he was alert and had left-sided paralysis. He had dysphagia and frequent coughing when he was consuming food. Before he was transferred to our Aspiration is defined as the inhalation of oropharyngeal or hospital, he had previously been admitted to another hospital gastric contents into the larynx and lower respiratory tract. for treatment of neurologic sequelae of a cerebral infarction. Aspiration is expected during anesthetic induction or surgery, Surgery, which had been scheduled for necrosis of the left but can also occur perioperatively. Sometimes aspiration foot, was delayed because of pneumonia. Preoperative labora- pneumonia can develop pulmonary infiltrates in patients who tory findings, chest X-ray, pulmonary function test and electro- have an increased risk of aspirating oropharyngeal or gastric cardiogram were within the normal range. contents. Pneumonia is a major cause of death in the elderly, At 06:30 on the day of surgery, nifedipine was administered indeed, morbidity and mortality increase with aging [1]. The orally with small amounts of water, at which time, he coughed administration of antihypertensive drugs with small amounts of several times. water is allowed before surgery. Nevertheless, we recognized Regional anesthesia was not considered because of the that in an elderly patient with a history of cerebral infarction, patient’s refusal. After preoxygenation, anesthesia was induced with propofol of 2 mg/kg and tracheal intubation was facili- Received: April 11, 2011. tated with rocuronium 40 mg. The anesthesiologist intubated Revised: 1st, April 26, 2011; 2nd, May 17, 2011. the trachea with an 8.0 mm internal diameter tracheal tube by Accepted: June 14, 2011. applying the Sellick’s maneuver. There were no signs of Corresponding author: Eun Jung Cho, M.D., Ph.D., Department of Anesthesiology and Pain Medicine, Inchoen St. Mary's Hospital, College aspiration at the time of intubation. After intubation, the of Medicine, The Catholic University of Korea, Bupyeong-dong, capnogram showed a mild obstructive pattern and mild Bupyeong-gu, Incheon 403-010, Korea. Tel: 82-32-280-5410, Fax: wheezing was auscultated in the right lower lung field. Several 82-32-280-5278, E-mail: [email protected] minutes later, the capnogram showed a normal pattern. 402 Soo Kyoung Park, Eun Jung Cho：Aspiration of antihypertensive drug 403 Fig. 1. Impacted nifedipine tablet in the removed tube (A), and comparison with original drug (B). pneumonia (Fig. 2). A chest x-ray on the 10th postoperative day showed regression of right lung infiltration. The vital signs were stable and no respiratory difficulty was noted during the hospital stay and the patient was discharged from the hospital 53 days after the event without any complication. DISCUSSION Pulmonary aspiration associated with anesthesia is widely viewed as the most common serious complication of anesthesia in otherwise healthy patients [2]. The overall risk for peria- nesthetic gastric aspiration has been placed at 1：3,000, with the risks of symptoms at 1：9,000 [3]. “Gold standard” 8-hour preoperative fast has been eroded Fig. 2. Chest x-ray shows ill defined patchy density in right middle and toward a range from 2 to 4 hours, depending on the lower lobe of lungs suggesting multifocal pneumonia. circumstances and the type of oral intake allowed [4]. For example, intake of water with an oral benzodiazepine as Anesthesia was maintained with sevoflurane 0.5−2.0 vol% premedication up to 1 h before induction of anesthesia does and nitrous oxide in oxygen at a ratio of 1：1. The not increase the gastric fluid volume. Up to 150 ml of water intraoperative course was uneventful, although hypotension was to swallow tablets has been accepted in adults and noted immediately before operation, ephedrine 10 mg was administration of antihypertensive drugs is recommended administered. preoperatively [5]. Thus, our patient took a nifedipine tablet The surgery lasted approximately 1 hour. At the end of with approximately 50 ml of water in the morning on the day surgery, all anesthetic agents were discontinued and the of surgery. respirations recovered spontaneously. After the residual This is the first report of aspiration pneumonia from neuromuscular blockade was reversed with pyridostigmine and antihypertensive drug premedicaion for anesthesia. There is a glycopyrrolate, bucking occurred briefly. Immediately after possibility that silent aspiration occurred during the induction strong bucking, the tracheal tube was removed without of anesthesia or intraoperatively. In conscious healthy patients, vomiting and he had sufficient spontaneous respirations. the upper esophageal sphincter (UES) helps prevent aspiration However, after extubation it was noted that there was an by sealing off the upper esophagus from the hypopharynx; impacted drug-like material in the endotracheal tube (Fig. 1). however, that function is impaired during anesthesia and On the 2nd postoperative day, a chest x-ray showed an ill normal sleep [6]. With the exception of ketamine, most defined patchy density in the right middle and lower lobes of anesthetic techniques are likely to reduce the UES tone and the lungs suggesting multifocal pneumonia including aspiration increase the likelihood of regurgitation of material from the 404 Anesth Pain Med Vol. 6, No. 4, 2011 esophagus into the hypopharynx [7]. have a high incidence of defective esophageal peristalsis that Because we used Sellick’s maneuver and no traces of gastric leads to impaired clearance of refluxed content [13]. A contents were observed in the mouth at the time of intubation, diminished cough reflex and a lack of coordination of it is unlikely that aspiration occurred during induction of swallowing and breathing are also occur in the aged [14]. anesthesia. Sellick’s maneuver has become standard practice In general, airway reflexes protect the lungs from aspiration, during the induction of anesthesia in patients with a potentially therefore, it is important to identify situations in which airway full stomach. The evidence in support of Sellick’s maneuver’s reflexes are impaired. Four well defined reflexes have been efficacy includes prevention of gastric insufflations in adults described in the upper airway, apnea with laryngospasm, and an increase in UES pressure [8]. coughing, expiration, spasmodic panting [12]. Protective airway Although it is known that a high-volume, low-pressure cuff reflexes may be impaired at any stage in the perioperative allows methylene blue dye to leak from the subglottis via the period, not only intraoperatively, but also in the preoperative longitudinal folds of the cuff into the trachea and does not period and after recovery from anesthesia, and maybe longer guarantee aspiration [9], tracheal intubation is still the gold than estimated from objective tests of recovery. The present standard in protecting the airway from aspiration in patient had coughing at the time of nifedipine ingestion, but anesthetized patients. The chance of nifedipine tablet aspiration we suggest that the coughing reflex might not have been is very low during anesthesia, so we suggest that pulmonary sufficient to protect him from aspiration at that time. aspiration occurred at the time of nifedipine ingestion in the Gastroesophageal reflux is also a risk factor for aspiration in morning of the day of surgery and the tablet went into the the elderly. Gastroesophageal reflux is caused by a reduction tracheal tube due to strong bucking immediately before of the lower esophageal sphincter pressure. Many elderly extubation. persons are taking various medications and some drug can Neurologic diseases that may cause dysphagia are associated cause a reduction in lower esophageal sphincter pressure. The with an increases in the incidence of aspiration and aspiration major drugs that can causes a reduction in lower esophageal
Load more

Recommended publications
  • Aspiration Pneumonia and Related Syndromes
    REVIEW Aspiration Pneumonia and Related Syndromes Augustine S. Lee, MD, and Jay H. Ryu, MD Abstract Aspiration is a syndrome with variable respiratory manifestations that span acute, life-threatening illnesses, such as acute respiratory distress syndrome, to chronic, sometimes insidious, respiratory disorders such as aspiration bronchiolitis. Diagnostic testing is limited by the insensitivity of histologic testing, and although gastric biomarkers for aspiration are increasingly available, none have been clinically validated. The leading mechanism for microaspiration is thought to be gastroesophageal reflux disease, largely driven by the increased prevalence of gastroesophageal reflux across a variety of respiratory disorders, including chronic obstructive pulmonary disease, asthma, idiopathic pulmonary fibrosis, and chronic cough. Failure of therapies targeting gastric acidity in clinical trials, in addition to increasing concerns about both the overuse of and adverse events associated with proton pump inhibitors, raise questions about the precise mechanism and causal link between gastroesophageal reflux and respiratory disease. Our review summarizes key aspiration syndromes with a focus on reflux-mediated aspiration and highlights the need for additional mechanistic studies to find more effective therapies for aspiration syndromes. ª 2018 Mayo Foundation for Medical Education and Research n Mayo Clin Proc. 2018;nn(n):1-11 ulmonary aspiration is the pathologic pas- unchallenged with empirical attempts at moder- From the Division of fl Pulmonary,
    [Show full text]
  • A Narrative Review of Minimally Invasive Fundoplication for Gastroesophageal Reflux Disease and Interstitial Lung Disease
    7 Review Article Page 1 of 7 A narrative review of minimally invasive fundoplication for gastroesophageal reflux disease and interstitial lung disease Nicola Tamburini1, Ciro Andolfi2,3, P. Marco Fisichella4 1Department of Human Morphology, Surgery, and Experimental Medicine, Section of Chirurgia 1, University of Ferrara School of Medicine, Ferrara, Italy; 2Department of Surgery and Center for Simulation, The University of Chicago Pritzker School of Medicine and Biological Sciences Division, Chicago, IL, USA; 3MacLean Center for Clinical Medical Ethics, The University of Chicago, Chicago, IL, USA; 4Department of Surgery, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA Contributions: (I) Conception and design: All authors; (II) Administrative support: None; (III) Provision of study materials or patients: None; (IV) Collection and assembly of data: None; (V) Data analysis and interpretation: N Tamburini; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors. Correspondence to: Nicola Tamburini. Department of Human Morphology, Surgery, and Experimental Medicine, Section of Chirurgia 1, University of Ferrara School of Medicine, Ferrara, Italy. Email: [email protected]. Abstract: Interstitial lung disease (ILD) encompasses a heterogeneous group of acute and chronic disorders characterized by diffuse pulmonary infiltrates with histologic features of pulmonary inflammation, dyspnea, and restrictive lung patterns. Gastroesophageal reflux disease (GERD) and ILD are two pathological conditions often strictly related, even if a clear relationship of causality has not been demonstrated. The mechanisms leading to ILD are not completely understood, although it is recognized that different factors are involved. In recent years, it has been suggested that acid gastroesophageal reflux is an important cause of both systemic sclerosis (SSc)-ILD and idiopathic pulmonary fibrosis (IPF).
    [Show full text]
  • Bronchiectasis in Chronic Pulmonary Aspiration: Risk Factors and Clinical Implications
    Pediatric Pulmonology 47:447–452 (2012) Bronchiectasis in Chronic Pulmonary Aspiration: Risk Factors and Clinical Implications 1 1 2 Joseph C. Piccione, DO, MS, Gary L. McPhail, MD, Matthew C. Fenchel, MS, 3 4 Alan S. Brody, MD, and Richard P. Boesch, DO, MS * Summary. Introduction: Bronchiectasis is a well-known sequela of chronic pulmonary aspira- tion (CPA) that can result in significant respiratory morbidity and death. However, its true preva- lence is unknown because diagnosis requires high resolution computed tomography which is not routinely utilized in this population. This study describes the prevalence, time course for development, and risk factors for bronchiectasis in children with CPA. Materials and Methods: Using a cross-sectional design, medical records were reviewed for all patients with swallow study or airway endoscopy-confirmed aspiration in our airway center over a 21 month period. All patients underwent rigid and flexible bronchoscopy, and high resolution chest computed tomography. Prevalence, distribution, and risk factors for bronchiectasis were identified. Results: One hundred subjects age 6 months to 19 years were identified. Overall, 66% had bronchiectasis, including 51% of those less than 2 years old. The youngest was 8 months old. Severe neurological impairment (OR 9.45, P < 0.004) and history of gastroesophageal reflux (OR 3.36, P ¼ 0.036) were identified as risk factors. Clinical history, exam, and other co-mor- bidities did not predict bronchiectasis. Sixteen subjects with bronchiectasis had repeat chest computed tomography with 44% demonstrating improvement or resolution. Discussion: Bron- chiectasis is highly prevalent in children with CPA and its presence in young children demon- strates that it can develop rapidly.
    [Show full text]
  • 2 Year Old Boy with Failure to Thrive ATS 2017
    2 year old boy with failure to thrive ATS 2017 Presenter: Discussant: Apeksha Sathyaprasad, MD Folasade O. Ogunlesi, MD Pediatric Pulmonary Fellow Assistant Professor of Pediatrics St. Louis Children’s Hospital/ Washington University in Children's National Medical Center/ The George St. Louis Washington University School of Medicine & Health Sciences History of Present Illness 2 year old African-American male admitted for septic shock, multiorgan dysfunction syndrome due to central line associated candidemia Initially presented to pediatrician’s office in respiratory distress and ultimately admitted to the PICU • Respiratory failure- intubated and on mechanical ventilatory support • Septic shock- vasopressors • Renal failure- continuous veno-venous hemofiltration Pulmonology consulted on hospital day #10 because of prolonged mechanical ventilatory support Pediatric Pulmonology Past Medical History Born full-term, birth weight 3.318 Kg. Pregnancy, delivery, newborn period was unremarkable. Did not require oxygen support, no history of delayed passage of meconium. No history of chronic persistent rhinitis or cough 1 year of age- chronic diarrhea and poor weight gain • Endoscopy, contrast imaging, hepatic enzymes, anti-tTG: unremarkable • Dietary modifications (higher calorie elemental formula) • G-tube with Nissen fundoplication • Chronic intravenous hyperalimentation Central line-associated blood stream infection • S. viridans, Klebsiella, E.coli, Enterococcus, S. aureus History of eczema, intermittent cough and wheezing with viral illnesses which reportedly responded to treatment with inhaled albuterol Pediatric Pulmonology Family and social history Family History: Grandmother has recurrent sinusitis. No history of asthma, cystic fibrosis, recurrent infections, infertility, gastrointestinal diseases Social history: Lives with mother and grandmother. Does not attend daycare. No second-hand tobacco exposure. No avian or agricultural exposures.
    [Show full text]
  • Pulmonary Aspiration Syndromes
    Pulmonary aspiration syndromes JEFFREY L. KAUFMAN, DD. JAMES C. GIUDICE, D.O., FCCP ROBERT GORDON, DD. Stratford, New Jersey is a change in function of the lower esophageal sphincter.4- 6 A change in the state of consciousness Aspiration of pharyngeal contents is as a result of an overdose of a sedative drug, general more common than aspiration of anesthesia, cerebrovascular accident, cardiopul- gastric contents, and three syndromes monary arrest, a seizure disorder, or alcoholic in- may result. Aspiration of gastric acid, toxication is the most common cause. The fre- of pathogenic bacteria, and of inert quency of aspiration problems is increased when a substances or particles cause different nasogastric tube or tracheostomy is present. clinical pictures, although in some In general, bacteria may reach the lung by any of instances they may be difficult to four routes: (1) aspiration, (2) inhalation, (3) differentiate. Since the three hematogenous spread, and (4) direct extension syndromes call for different from a contiguous site. In one study, 45 percent of management, it is important to normal subjects were noted to have aspirated identify the particular syndrome. The pharyngeal contents during sleep. Of patients with prognosis for aspiration of stomach a depressed sensorium, 70 percent aspirated phar- contents varies with the acidity. When yngeal contents. airway obstruction is due to aspiration By adding barium sulfate to beverages of of an inert object, the prognosis is ninety-four patients and placing barium in the excellent if obstruction is relieved stomach by tube in another fifty-one patients, quickly. Gardners demonstrated aspiration of pharyngeal contents into the lungs of ten of the first ninety-four patients and aspiration of gastric contents in only one of the second fifty-one patients.
    [Show full text]
  • The Diagnosis and Management of Sinusitis: a Practice Parameter Update
    The diagnosis and management of sinusitis: A practice parameter update Chief Editors: Raymond G. Slavin, MD, Sheldon L. Spector, MD, and I. Leonard Bernstein, MD Sinusitis Update Workgroup: Chairman—Raymond G. Slavin, MD; Members—Michael A. Kaliner, MD, David W. Kennedy, MD, Frank S. Virant, MD, and Ellen R. Wald, MD Joint Task Force Reviewers: David A. Khan, MD, Joann Blessing-Moore, MD, David M. Lang, MD, Richard A. Nicklas, MD,* John J. Oppenheimer, MD, Jay M. Portnoy, MD, Diane E. Schuller, MD, and Stephen A. Tilles, MD Reviewers: Larry Borish, MD, Robert A. Nathan, MD, Brian A. Smart, MD, and Mark L. Vandewalker, MD These parameters were developed by the Joint Task Force on Practice participants, no single individual, including those who served on Parameters, representing the American Academy of Allergy, Asthma the Joint Task force, is authorized to provide an official AAAAI or and Immunology; the American College of Allergy, Asthma and ACAAI interpretation of these practice parameters. Any request for Immunology; and the Joint Council of Allergy, Asthma and information about or an interpretation of these practice parameters Immunology. by the AAAAI or the ACAAI should be directed to the Executive Offices of the AAAAI, the ACAAI, and the Joint Council of Allergy, The American Academy of Allergy, Asthma and Immunology (AAAAI) Asthma and Immunology. These parameters are not designed for and the American College of Allergy, Asthma and Immunology use by pharmaceutical companies in drug promotion. (ACAAI) have jointly accepted responsibility for establishing ‘‘The diagnosis and management of sinusitis: a practice parameter Published practice parameters of the Joint Task Force update.’’ This is a complete and comprehensive document at the current time.
    [Show full text]
  • Chapter 15 the PROBLEMS with CONSTRICTIVE BRONCHIOLITIS: HISTOPATHOLOGICAL and RADIOLOGICAL PERSPECTIVES
    The Problems With Constrictive Bronchiolitis Chapter 15 THE PROBLEMS WITH CONSTRICTIVE BRONCHIOLITIS: HISTOPATHOLOGICAL AND RADIOLOGICAL PERSPECTIVES MICHAEL R. LEWIN-SMITH, MB, BS*; MICHAEL J. MORRIS, MD†; JEFFREY R. GALVIN, MD‡; RUSSELL A. HARLEY, § § MD ; AND TERI J. FRANKS, MD INTRODUCTION HISTOPATHOLOGICAL CLASSIFICATION OF NONNEOPLASTIC LUNG DISEASE WHAT IS THE REPERTOIRE OF HISTOLOGICAL RESPONSES OF HUMAN LUNG TISSUE? HOW DO PARTICLE SIZE AND COMPOSITION AFFECT THE DISTRIBUTION OF INHALED MATERIALS? WHAT IS CONSTRICTIVE BRONCHIOLITIS? WHAT ARE THE KNOWN ASSOCIATIONS OF CONSTRICTIVE BRONCHIOLITIS? WHAT ARE THE LIMITS OF HISTOPATHOLOGY? WHAT IS THE ROLE OF RADIOLOGY? WHAT OTHER INFLUENCES IMPACT THE DIAGNOSIS OF CONSTRICTIVE BRONCHIOLITIS? SUMMARY *Senior Environmental Pathologist, The Joint Pathology Center, Joint Task Force National Capital Region Medical, 606 Stephen Sitter Avenue, Silver Spring, MD 20910-1290 †Colonel (Retired), Medical Corps, US Army; Department of Defense Chair, Staff Physician, Pulmonary/Critical Care Medicine and Assistant Program Director, Internal Medicine Residency, San Antonio Military Medical Center, 3551 Roger Brooke Drive, Fort Sam Houston, Texas 78234 ‡Professor, Departments of Diagnostic Radiology, Thoracic Imaging, and Internal Medicine, Pulmonary/Critical Care Medicine, University of Maryland School of Medicine, 685 West Baltimore Street, Baltimore, MD 21201 §Senior Pulmonary and Mediastinal Pathologist, The Joint Pathology Center, Joint Task Force National Capital Region Medical, 606 Stephen Sitter Avenue, Silver Spring, MD 20910-1290 153 Airborne Hazards Related to Deployment INTRODUCTION Much of the focus of pulmonary health issues following to human waste, and combat smoke were reported exposures deployment of US service members to Iraq and Afghanistan for between 33 of 38 (87%) and 17 of 38 (45%).
    [Show full text]
  • Gastroesophageal Reflux and Idiopathic Pulmonary Fibrosis
    World J Surg (2017) 41:1691–1697 DOI 10.1007/s00268-017-3956-0 SURGICAL SYMPOSIUM CONTRIBUTION Gastroesophageal Reflux and Idiopathic Pulmonary Fibrosis 1 1 1 2 Marco E. Allaix • Fabrizio Rebecchi • Mario Morino • Francisco Schlottmann • Marco G. Patti2 Published online: 3 March 2017 Ó Socie´te´ Internationale de Chirurgie 2017 Abstract Background Idiopathic pulmonary fibrosis (IPF) is a progressive interstitial lung disease of unknown origin that affects about 40,000 new patients every year in the USA. Albeit the disease is labelled as idiopathic, it is thought that pathologic reflux, often silent, plays a role in its pathogenesis through a process of microaspiration of gastric contents. Aims The aim of this study was to review the available evidence linking reflux to IPF, and to study the effect of medical and surgical therapy on the natural history of this disease. Results Medical therapy with acid-reducing medications controls the production of acid and has some benefit. However, reflux and aspiraion of weakly acidic or alkaline gastric contents can still occur. Better results have been reported after laparoscopic anti-reflux surgery, as this form of therapy re-establishes the competence of the lower esophageal sphincter, therefore stopping any type of reflux. Conclusions A phase II NIH study in currently in progress in the USA to determine the role of antireflux surgery in patients with GERD and IPF. The hope is that this simple operations might alter the natural history of IPF, avoiding progression and the need for lung transplantation. Introduction development of the disease. Chronic microaspiration of gastric refluxate might be one of these insulting factors Idiopathic pulmonary fibrosis (IPF) is a chronic and irre- involved in the pathogenesis of IPF [3].
    [Show full text]
  • Aspiration Pneumonia HOSPITAL HARM IMPROVEMENT RESOURCE Aspiration Pneumonia
    HOSPITAL HARM IMPROVEMENT RESOURCE Aspiration Pneumonia HOSPITAL HARM IMPROVEMENT RESOURCE Aspiration Pneumonia ACKNOWLEDGEMENTS The Canadian Institute for Health Information and the Canadian Patient Safety Institute have collaborated on a body of work to address gaps in measuring harm and to support patient safety improvement efforts in Canadian hospitals. The Hospital Harm Improvement Resource was developed by the Canadian Patient Safety Institute to complement the Hospital Harm measure developed by the Canadian Institute for Health Information. It links measurement and improvement by providing evidence-informed resources that will support patient safety improvement efforts. The Canadian Patient Safety Institute acknowledges and appreciates the key contributions of Dr. Claudio Martin, MD FRCPC; Rosemary Martino, MA MSc PhD, and Andrea Hatherall, Reg. CASLPO, M.Cl.Sc. for the review and approval of this Improvement Resource. October 2016 2 HOSPITAL HARM IMPROVEMENT RESOURCE Aspiration Pneumonia DISCHARGE ABSTRACT DATABASE (DAD) CODES INCLUDED IN THIS CLINICAL CATEGORY: B16: Aspiration Pneumonia Concept Inflammation and infection of the lungs caused by aspiration of solids or liquids during a hospital stay. Notes 1. When both aspiration pneumonitis and pneumonia are coded on the same abstract, the event will be included in this clinical group only. 2. This clinical group may include inflammation due to aspiration in the absence of infection. 3. Aspiration pneumonia due to methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant enterococci (VRE) can also be included in B18: Infections Due to Clostridium difficile, MRSA or VRE. Selection criteria J69. Identified as diagnosis type (2) OR Identified as diagnosis type (3) AND J95.88 as diagnosis type (2) AND Y60–Y84 in the same diagnosis cluster Exclusions Abstracts with a length of stay less than 2 days Codes Code descriptions J69.
    [Show full text]
  • Forensic Lung Pathology
    31 Forensic Lung Pathology Michael A. Graham Sudden and unexpected natural deaths and nonnatural The cause of death is the disease or injury that begins deaths may result from various pulmonary conditions. the unbroken pathophysiologic sequence leading to Additionally, several nonpulmonary conditions of foren­ death. The disease/injury that causes death at a particular sic significance may be complicated by the development time is often referred to as the immediate cause of death. of respiratory lesions. Certain situations with pulmonary The disease/injury that starts the unbroken chain of pathology are particularly likely to be critically scruti­ medical events culminating in death is referred to as the nized and may form the basis of allegations of medical underlying cause of death. Proper recognition of the latter negligence, other personal injury liability, or wrongful is very important for death certification, epidemiology, death.l public policy, and the proper resolution of criminal justice The forensic evaluation of lethal or nonlethal conditions and civil liability issues. 2 The mechanism of death is the is essentially the same and conceptually differs little from nonspecific pathophysiologic alteration through which a clinician's approach to a patient with a similar condition the cause of death exerts its lethal influence. The manner (Table 31.1). In some cases this diagnostic/investigative of death is a term peculiar to death certification that process is quite broad, whereas in other cases the issues describes how death came about-through natural causes, are of very limited scope and the investigation may be homicide, suicide, or accident.2 The determination of the narrowly focused.
    [Show full text]
  • Respiratory Failure After Pulmonary Aspiration
    Respiratory failure after pulmonary aspiration 1 1 1, 2 Hammermüller S. , Waldmann A. , Böhm S.H. Iotti G. 1 Swisstom AG, Landquart, Switzerland 2 Fondazione IRCCS Policlinico San Matteo, Pavia, Italy INTRODUCTION The aspiration of gastric contents and inhalation of pharyngeal secretions during and after intubation is associated with pulmonary morbidity and higher mortality [1]. Furthermore, emergency intubation is associated with a high risk of aspirating gastric contents or laryngeal fluids [2]. SITUATION After operative evacuation and debridement of multiple neck abscesses, a 38 year old female was mechanically ventilated for 20 hours postoperatively on the ICU. After positive spontaneous breathing trial, the patient was extubated. Right after extubation the patient presented with considerable respiratory insufficiency - possibly due to laryngeal obstruction. Emergency reintubation proved difficult but successful. Mechanical ventilation was possible only at high inspiratory pressures since the right hemithorax did not show any expansion with inspiration. Airway resistance was high and oxygenation severely impaired. EIT-GUIDED TREATMENT In an attempt to explain the altered respiratory mechanics and progressive desaturation Swisstom BB2 was applied to obtain insights into the regional distribution of ventilation. Figure 1: Image courtesy of Dr. Giorgio Iotti, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy Right after applying the SensorBelt and starting Swisstom BB2 it became obvious that ventilation was mainly distributed towards the left lung while the right lung showed reduced ventilation and a huge SilentSpace in the right lower lung (Figure 1, immediately after reintubation). At this time, the patient was haemodynamicly stable, but a pneumothorax, which could explain the missing unilateral ventilation, had to be excluded.
    [Show full text]
  • High Prevalence of Abnormal Acid Gastro-Oesophageal Reflux in Idiopathic Pulmonary Fibrosis
    Eur Respir J 2006; 27: 136–142 DOI: 10.1183/09031936.06.00037005 CopyrightßERS Journals Ltd 2006 High prevalence of abnormal acid gastro-oesophageal reflux in idiopathic pulmonary fibrosis G. Raghu*, T.D. Freudenberger*, S. Yang#, J.R. Curtis*, C. Spada*, J. Hayes*, J.K. Sillery", C.E. Pope II" and C.A. Pellegrini" ABSTRACT: The aim of this prospective study was to determine the prevalence and AFFILIATIONS characteristics of acid gastro-oesophageal reflux (GER) in patients with idiopathic pulmonary *Division of Pulmonary and Critical Care Medicine, Dept of Medicine, fibrosis (IPF). and Sixty-five consecutive patients with well-defined IPF were subjected to 24-h pH monitoring and "Gastrointestinal Motility Clinic, Dept oesophageal manometry. A total of 133 consecutive patients with intractable asthma and of Surgery, University of Washington, symptoms of GER were used as comparisons. Seattle, WA, USA. #Dept of Respiratory and Critical The prevalence of abnormal acid GER in IPF patients was 87%, with 76% and 63% Care Medicine, Singapore General demonstrating abnormal distal and proximal oesophageal acid exposures, respectively. Hospital, Singapore. Abnormal acid GER was significantly more common in IPF patients than asthma patients. Only 47% of IPF patients experienced classic GER symptoms. Despite treatment with standard doses CORRESPONDENCE G. Raghu of proton pump inhibitors (PPIs), 12 out of 19 patients receiving PPIs during the 24-h pH Division of Pulmonary and Critical monitoring had abnormal oesophageal acid exposures by pH probe. There was no correlation Care Medicine between IPF severity and acid GER severity. University of Washington Medical In conclusion, abnormal acid gastro-oesophageal reflux is highly prevalent, but often clinically Center Campus Box 356522 occult in patients with idiopathic pulmonary fibrosis.
    [Show full text]