Pharmacologic prevention of aspiration pneumonia: A systematic review

Saliba, Ranime

doi:10.1016/j.amjopharm.2007.12.005

Cited by 39 publications

(21 citation statements)

References 63 publications

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“…Mosapride citrate is a prokinetic drug that promotes upper gastrointestinal motility and prevents gastroesophageal reflux, and was also shown to reduce the incidence of aspiration pneumonia . ACEI also have been shown to be effective in reducing the risk of aspiration . However, just nine patients were treated with ACEI, and 18 patients were using mosapride citrate.…”

Section: Discussionmentioning

confidence: 99%

Use of proton pump inhibitors is associated with increased mortality due to nosocomial pneumonia in bedridden patients receiving tube feeding

Hamai

Iwamoto

Ohshimo

et al. 2018

Geriatrics Gerontology Int

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Section: Discussionmentioning

confidence: 99%

Use of proton pump inhibitors is associated with increased mortality due to nosocomial pneumonia in bedridden patients receiving tube feeding

Hamai

Iwamoto

Ohshimo

et al. 2018

Geriatrics Gerontology Int

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“…El Solh et al . reviewed ways to prevent aspiration pneumonia and concluded that few data were available to guide an evidence-based approach to the prevention using drugs such as angiotensin-converting enzyme inhibitors or capsaicin78. The evidence relating to non-pharmacologic approaches; swallowing rehabilitation, thickening feeds, oral hygiene, gastroesophageal reflux management, and a head-up position are also limited, but the combination approach using pharmacologic and non-pharmacologic methods may be of value in high risk patients7980.…”

Section: Discussionmentioning

confidence: 99%

Prognostic implications of aspiration pneumonia in patients with community acquired pneumonia: A systematic review with meta-analysis

Komiya

Rubin

Kadota

et al. 2016

Sci Rep

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Aspiration pneumonia is thought to be associated with a poor outcome in patients with community acquired pneumonia (CAP). However, there has been no systematic review regarding the impact of aspiration pneumonia on the outcomes in patients with CAP. This review was conducted using the MOOSE guidelines: Patients: patients defined CAP. Exposure: aspiration pneumonia defined as pneumonia in patients who have aspiration risk. Comparison: confirmed pneumonia in patients who were not considered to be at high risk for oral aspiration. Outcomes: mortality, hospital readmission or recurrent pneumonia. Three investigators independently identified published cohort studies from PubMed, CENTRAL database, and EMBASE. Nineteen studies were included for this systematic review. Aspiration pneumonia increased in-hospital mortality (relative risk, 3.62; 95% CI, 2.65–4.96; P < 0.001, seven studies) and 30-day mortality (3.57; 2.18–5.86; P < 0.001, five studies). In contrast, aspiration pneumonia was associated with decreased ICU mortality (relative risk, 0.40; 95% CI, 0.26–0.60; P < 0.00001, four studies). Although there are insufficient data to perform a meta-analysis on long-term mortality, recurrent pneumonia, and hospital readmission, the few reported studies suggest that aspiration pneumonia is also associated with these poor outcomes. In conclusion, aspiration pneumonia was associated with both higher in-hospital and 30-day mortality in patients with CAP outside ICU settings.

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“…Generally, pneumonia patients are treated according to guidelines, which basically prescribe the application of antibiotics . Treatments other than antibiotics for aspiration pneumonia are prophylactic, such as by improving cough or swallowing reflexes . The cough reflex is improved by the administration of angiotensin‐converting enzyme inhibitor, an anti‐hypertensive medicine, and capsaicin, a pungent in red chilli peppers .…”

Section: Introductionmentioning

confidence: 99%

Aspiration pneumonia induces muscle atrophy in the respiratory, skeletal, and swallowing systems

Komatsu

Okazaki

Ebihara

et al. 2018

J cachexia sarcopenia muscle

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BackgroundRepetition of the onset of aspiration pneumonia in aged patients is common and causes chronic inflammation. The inflammation induces proinflammatory cytokine production and atrophy in the muscles. The proinflammatory cytokines induce muscle proteolysis by activating calpains and caspase‐3, followed by further degradation by the ubiquitin‐proteasome system. Autophagy is another pathway of muscle atrophy. However, little is known about the relationship between aspiration pneumonia and muscle. For swallowing muscles, it is not clear whether they produce cytokines. The main objective of this study was to determine whether aspiration pneumonia induces muscle atrophy in the respiratory (the diaphragm), skeletal (the tibialis anterior, TA), and swallowing (the tongue) systems, and their possible mechanisms.MethodsWe employed a mouse aspiration pneumonia model and computed tomography (CT) scans of aged pneumonia patients. To induce aspiration pneumonia, mice were inoculated with low dose pepsin and lipopolysaccharide solution intra‐nasally 5 days a week. The diaphragm, TA, and tongue were isolated, and total RNA, proteins, and frozen sections were stored. Quantitative real‐time polymerase chain reaction determined the expression levels of proinflammatory cytokines, muscle E3 ubiquitin ligases, and autophagy related genes. Western blot analysis determined the activation of the muscle proteolysis pathway. Frozen sections determined the presence of muscle atrophy. CT scans were used to evaluate the muscle atrophy in aged aspiration pneumonia patients.ResultsThe aspiration challenge enhanced the expression levels of proinflammatory cytokines in the diaphragm, TA, and tongue. Among muscle proteolysis pathways, the aspiration challenge activated caspase‐3 in all the three muscles examined, whereas calpains were activated in the diaphragm and the TA but not in the tongue. Activation of the ubiquitin‐proteasome system was detected in all the three muscles examined. The aspiration challenge activated autophagy in the TA and the tongue, whereas weak or little activation was detected in the diaphragm. The aspiration challenge resulted in a greater proportion of smaller myofibers than in controls in the diaphragm, TA, and tongue, suggesting muscle atrophy. CT scans clearly showed that aspiration pneumonia was followed by muscle atrophy in aged patients.ConclusionsAspiration pneumonia induced muscle atrophy in the respiratory, skeletal, and swallowing systems in a preclinical animal model and in human patients. Diaphragmatic atrophy may weaken the force of cough to expectorate sputum or mis‐swallowed contents. Skeletal muscle atrophy may cause secondary sarcopenia. The atrophy of swallowing muscles may weaken the swallowing function. Thus, muscle atrophy could become a new therapeutic target of aspiration pneumonia.

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Pharmacologic prevention of aspiration pneumonia: A systematic review

Cited by 39 publications

References 63 publications

Use of proton pump inhibitors is associated with increased mortality due to nosocomial pneumonia in bedridden patients receiving tube feeding

Use of proton pump inhibitors is associated with increased mortality due to nosocomial pneumonia in bedridden patients receiving tube feeding

Prognostic implications of aspiration pneumonia in patients with community acquired pneumonia: A systematic review with meta-analysis

Aspiration pneumonia induces muscle atrophy in the respiratory, skeletal, and swallowing systems

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