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Pepsin aspiration

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https://www.readbyqxmd.com/read/28303301/impact-of-tapered-cuff-tracheal-tube-on-microaspiration-of-gastric-contents-in-intubated-critically-ill-patients-a-multicenter-cluster-randomized-cross-over-controlled-trial
#1
Emmanuelle Jaillette, Christophe Girault, Guillaume Brunin, Farid Zerimech, Hélène Behal, Arnaud Chiche, Céline Broucqsault-Dedrie, Cyril Fayolle, Franck Minacori, Isabelle Alves, Stéphanie Barrailler, Julien Labreuche, Laurent Robriquet, Fabienne Tamion, Emmanuel Delaporte, Damien Thellier, Claire Delcourte, Alain Duhamel, Saad Nseir
PURPOSE: Studies on the impact of tapered-cuff tracheal tubes on rates of microaspiration and ventilator-associated pneumonia (VAP) in intubated patients have reported conflicting results. The aim of this study was to determine the influence of this shape of tracheal cuff on abundant microaspiration of gastric contents in critically ill patients. METHODS: All patients intubated in the intensive care unit (ICU) and requiring mechanical ventilation for at least 48 h were eligible for this multicenter cluster-randomized controlled cross-over open-label study...
March 16, 2017: Intensive Care Medicine
https://www.readbyqxmd.com/read/28300572/the-potential-role-of-aspiration-in-the-asthmatic-airway
#2
Eoin B Hunt, Chris Ward, Stephen Power, Ashley Sullivan, Jeffrey Pearson, Susan Lapthorne, Paul M O'Byrne, Joseph Eustace, Barry J Plant, Michael M Maher, John MacSharry, Desmond M Murphy
BACKGROUND: Many asthmatics remain sub-optimally controlled despite current treatments. Reasons include comorbidities that could aggravate asthma, including gastro-esophageal reflux (GER). We aimed to investigate whether aspiration occurs in asthmatic patients and if so does it correlate with asthma control. METHODS: Patients had ACQ-7, FeNO, and spirometry performed to characterize their level of asthma control. Barium swallow with provocation was performed to assess for predisposition to aspiration...
March 11, 2017: Chest
https://www.readbyqxmd.com/read/28214603/the-impact-of-reduced-gastric-acid-secretion-on-dissolution-of-salts-of-weak-bases-in-the-fasted-upper-gastrointestinal-lumen-data-in-biorelevant-media-and-in-human-aspirates
#3
Chara Litou, Maria Vertzoni, Wei Xu, Filippos Kesisoglou, Christos Reppas
PURPOSE: To propose media for simulating the intragastric environment under reduced gastric acid secretion in the fasted state at three levels of simulation of the gastric environment and evaluate their usefulness in evaluating the intragastric dissolution of salts of weak bases. To evaluate the importance of bicarbonate buffer in biorelevant in vitro dissolution testing when using Level II biorelevant media simulating the environment in the fasted upper small intestine, regardless of gastric acid secretions...
February 15, 2017: European Journal of Pharmaceutics and Biopharmaceutics
https://www.readbyqxmd.com/read/27704488/efficiency-of-an-electronic-device-in-controlling-tracheal-cuff-pressure-in-critically-ill-patients-a-randomized-controlled-crossover-study
#4
Anahita Rouzé, Julien De Jonckheere, Farid Zerimech, Julien Labreuche, Erika Parmentier-Decrucq, Benoit Voisin, Emmanuelle Jaillette, Patrice Maboudou, Malika Balduyck, Saad Nseir
BACKGROUND: Despite intermittent control of tracheal cuff pressure (P cuff) using a manual manometer, cuff underinflation (<20 cmH2O) and overinflation (>30 cmH2O) frequently occur in intubated critically ill patients, resulting in increased risk of microaspiration and tracheal ischemic lesions. The primary objective of our study was to determine the efficiency of an electronic device in continuously controlling P cuff. The secondary objective was to determine the impact of this device on the occurrence of microaspiration of gastric or oropharyngeal secretions...
December 2016: Annals of Intensive Care
https://www.readbyqxmd.com/read/27646537/respiratory-symptoms-sleep-disordered-breathing-and-biomarkers-in-nocturnal-gastroesophageal-reflux
#5
Össur Ingi Emilsson, Bryndís Benediktsdóttir, Ísleifur Ólafsson, Elizabeth Cook, Sigurður Júlíusson, Einar Stefán Björnsson, Sunna Guðlaugsdóttir, Anna Soffía Guðmundsdóttir, Ekaterina Mirgorodskaya, Evert Ljungström, Erna Sif Arnardóttir, Þórarinn Gíslason, Christer Janson, Anna-Carin Olin
BACKGROUND: Nocturnal gastroesophageal reflux (nGER) is associated with respiratory symptoms and sleep-disordered breathing (SDB), but the pathogenesis is unclear. We aimed to investigate the association between nGER and respiratory symptoms, exacerbations of respiratory symptoms, SDB and airway inflammation. METHODS: Participants in the European Community Respiratory Health Survey III in Iceland with nGER symptoms (n = 48) and age and gender matched controls (n = 42) were studied by questionnaires, exhaled breath condensate (EBC), particles in exhaled air (PEx) measurements, and a home polygraphic study...
2016: Respiratory Research
https://www.readbyqxmd.com/read/27522714/-incidence-pathomorphism-and-outcomes-of-the-bronchopulmonary-dysplasia-associated-with-microaspiration-of-gastric-contents
#6
E Y Bryksina, V S Bryksin, A V Pochivalov
UNLABELLED: Today the influence of the digestive tract functional violations followed by microaspiration of gastric contents (MAGC) on the incidence, features and outcomes of bronchopulmonary dysplasia BPD) remains little studied. Focusing on this aspect makes the research actual. OBJECTIVE: determination of the nature of influence of MAGC on the progress and course of BPD. METHODS: 373 newborns exposed to artificial pulmonary ventilation (APV) in the neonatal period were examined...
2016: Vestnik Rossiĭskoĭ Akademii Meditsinskikh Nauk
https://www.readbyqxmd.com/read/27516725/clinical-utility-of-bronchoalveolar-lavage-pepsin-in-diagnosis-of-gastroesophageal-reflux-among-wheezy-infants
#7
Ahmed Fathi Abdallah, Tarek El-Desoky, Khalid Fathi, Wagdy Fawzi Elkashef, Ahmed Zaki
Background. There is no gold standard test for diagnosis of gastroesophageal reflux disease (GERD) associated infantile wheezing. Objectives. To evaluate the value of bronchoalveolar lavage (BAL) pepsin assay in diagnosis of GERD in wheezy infants. Methods. Fifty-two wheezy infants were evaluated for GERD using esophageal combined impedance-pH (MII-pH) monitoring, esophagogastroduodenoscopy with esophageal biopsies, and BAL pepsin. Tracheobronchial aspirates from 10 healthy infants planned for surgery without history of respiratory problems were examined for pepsin...
2016: Canadian Respiratory Journal: Journal of the Canadian Thoracic Society
https://www.readbyqxmd.com/read/27273863/a-pilot-randomized-clinical-trial-assessing-the-effect-of-cricoid-pressure-on-risk-of-aspiration
#8
J Kyle Bohman, Rahul Kashyap, Augustine Lee, Zhaoping He, Sam Soundar, Laura L Bolling, Daryl J Kor
INTRODUCTION: Patients at risk for microaspiration during elective intubation often receive cricoid pressure in the hopes of mitigating such risk. However, there is scarce evidence to either support or reject this practice. The objective of this investigation was to assess the effect of cricoid pressure on microaspiration and to inform the potential feasibility of conducting a larger, more definitive clinical trial. METHODS: This was a pilot randomized clinical trial set in the operating rooms of a tertiary referral hospital between August and October of 2014...
June 7, 2016: Clinical Respiratory Journal
https://www.readbyqxmd.com/read/26890709/pepsinogen-identification-in-the-middle-ear-fluid-of-children-with-otitis-media-with-effusion
#9
COMPARATIVE STUDY
Aytuğ Buyruk, Üstün Osma, Mustafa Deniz Yılmaz, Hülya Eyigör
OBJECTIVES: This study aims to investigate the presence and concentration of pepsin/pepsinogen in middle ear fluid and to discuss the potential mechanisms involved in the pathogenesis of this condition. PATIENTS AND METHODS: A total of 33 children (21 boys, 12 girls; mean age 5.7±2.4 years; range 3 to 13 years) diagnosed with otitis media with effusion and scheduled for operation were enrolled into the study. Fluids aspirated from the middle ear were assessed for the presence of pepsinogen and albumin and blood samples were drawn simultaneously for comparison...
2016: Kulak Burun Boğaz Ihtisas Dergisi: KBB, Journal of Ear, Nose, and Throat
https://www.readbyqxmd.com/read/26872366/tapered-cuff-endotracheal-tube-does-not-prevent-early-postoperative-pneumonia-compared-with-spherical-cuff-endotracheal-tube-after-major-vascular-surgery-a-randomized-controlled-trial
#10
RANDOMIZED CONTROLLED TRIAL
Antoine Monsel, Qin Lu, Marine Le Corre, Hélène Brisson, Charlotte Arbelot, Corinne Vezinet, Marie-Hélène Fléron, Christina Ibanez-Estève, Farid Zerimech, Malika Balduyck, Felippe Dexheimer, Chunyao Wang, Olivier Langeron, Jean-Jacques Rouby, Liliane Bodin, Romain Deransy, Pierre Garçon, Hatem Douiri, Ismael Khalifa, Antoine Pons, Wen-Jie Gu, Fabien Koskas, Julien Gaudric
BACKGROUND: Patients undergoing major vascular surgery often develop postoperative pneumonia that impacts their outcomes. Conflicting data exist concerning the potential benefit of tapered-shaped cuffs on tracheal sealing. The primary objective of this study was to assess the efficiency of a polyvinyl chloride tapered-cuff endotracheal tube at reducing the postoperative pneumonia rate after major vascular surgery. Secondary objectives were to determine its impact on microaspiration, ventilator-associated pneumonia rate, and inner cuff pressure...
May 2016: Anesthesiology
https://www.readbyqxmd.com/read/26794490/gastroesophageal-reflux-burden-even-in-children-that-aspirate-does-not-increase-pediatric-hospitalization
#11
Daniel R Duncan, Janine Amirault, Nikki Johnston, Paul Mitchell, Kara Larson, Rachel L Rosen
OBJECTIVES: Gastroesophageal reflux is common but remains a controversial disease to diagnose and treat and little is known about the role of reflux testing in predicting clinical outcomes, particularly in children at risk for extraesophageal reflux complications. The aim of this study was to determine if rates of hospitalization were affected by reflux burden even after adjusting for aspiration risk. METHODS: We prospectively recruited, between 2009 and 2014, a cohort of pediatric patients with suspected extraesophageal reflux disease who were referred for reflux testing and underwent both multichannel intraluminal impedance with pH (pH-MII) and modified barium swallow studies...
August 2016: Journal of Pediatric Gastroenterology and Nutrition
https://www.readbyqxmd.com/read/26407612/impact-of-tracheal-cuff-shape-on-microaspiration-of-gastric-contents-in-intubated-critically-ill-patients-study-protocol-for-a-randomized-controlled-trial
#12
RANDOMIZED CONTROLLED TRIAL
Emmanuelle Jaillette, Guillaume Brunin, Christophe Girault, Farid Zerimech, Arnaud Chiche, Céline Broucqsault-Dedrie, Cyril Fayolle, Franck Minacori, Isabelle Alves, Stephanie Barrailler, Laurent Robriquet, Fabienne Tamion, Emmanuel Delaporte, Damien Thellier, Claire Delcourte, Alain Duhamel, Saad Nseir
BACKGROUND: Ventilator-associated pneumonia (VAP) is the most common infection in intubated critically ill patients. Microaspiration of the contaminated gastric and oropharyngeal secretions is the main mechanism involved in the pathophysiology of VAP. Tracheal cuff plays an important role in stopping the progression of contaminated secretions into the lower respiratory tract. Previous in vitro studies suggested that conical cuff shape might be helpful in improving tracheal sealing. However, clinical studies found conflicting results...
September 25, 2015: Trials
https://www.readbyqxmd.com/read/26238826/pepsin-a-silent-biomarker-for-reflux-aspiration-or-an-active-player-in-extra-esophageal-mucosal-injury
#13
EDITORIAL
Peter J Kahrilas, Leila Kia
No abstract text is available yet for this article.
August 2015: Chest
https://www.readbyqxmd.com/read/26104973/gastroesophageal-reflux-and-lung-disease
#14
EDITORIAL
Keith C Meyer
Gastroesophageal reflux (GER) can cause respiratory symptoms and may trigger, drive and/or worsen airway disorders, interstitial lung diseases and lung allograft dysfunction. Whether lifestyle changes and acid suppression alone can counter and prevent the adverse effects of GER on the respiratory tract remains unclear. Recent data suggest that antireflux surgery may be more effective in preventing lung disease progression in patients with idiopathic pulmonary fibrosis or lung transplant recipients who have evidence of allograft dysfunction associated with the presence of excessive GER...
August 2015: Expert Review of Respiratory Medicine
https://www.readbyqxmd.com/read/26004028/correlation-between-laryngobronchoscopy-and-pepsin-in-the-diagnosis-of-extra-oesophageal-reflux
#15
U Krishnan, S Paul, I Messina, M Soma
OBJECTIVE: This study aimed to investigate pepsin as a marker of extra-oesophageal reflux disease by examining its presence in tracheal aspirates and correlating it with macroscopic changes on laryngobronchoscopy, along with the results of standard tests for gastro-oesophageal reflux disease and clinical features. METHODS: A retrospective review was undertaken of a cohort of 188 paediatric patients who underwent laryngobronchoscopy at a tertiary children's hospital and for whom pepsin assay results of tracheal aspirates were available...
June 2015: Journal of Laryngology and Otology
https://www.readbyqxmd.com/read/25934723/withholding-or-continuing-enteral-feedings-during-repositioning-and-the-incidence-of-aspiration
#16
MULTICENTER STUDY
Justin DiLibero, Mary Lavieri, Sharon O'Donoghue, Susan DeSanto-Madeya
BACKGROUND: Withholding enteral feedings during repositioning is based on tradition, but available evidence does not support this practice. Although research indicates that withholding of enteral feedings during repositioning contributes to undernourishment, the relationship between continuing enteral feedings during repositioning and the incidence of aspiration has not been determined. OBJECTIVE: To determine the feasibility of a study designed to explore differences in the incidence of aspiration when enteral feedings are withheld or continued during repositioning...
May 2015: American Journal of Critical Care: An Official Publication, American Association of Critical-Care Nurses
https://www.readbyqxmd.com/read/25764895/-the-determination-of-stomach-contents-left-on-the-material-objects-and-in-the-environment
#17
A V Sumin
The objective of the present experimental study was to develop the qualitatively new method for the determination of stomach contents left on the material objects and in the environment with special reference to the cases of aspiration asphyxia. We proposed the original approach for the determination of the origin of the traces of stomach contents based on the detection of pepsin, an enzyme that digests in the acidic milieu protein substances, such as gelatin (hydrolyzed collagen), a component of the emulsion layer of X-ray and photographic films...
November 2014: Sudebno-meditsinskaia Ekspertiza
https://www.readbyqxmd.com/read/25654241/acid-and-weakly-acidic-gastroesophageal-reflux-and-pepsin-isoforms-a-and-c-in-tracheal-secretions-of-critically-ill-children
#18
Cristiane Hallal, Veridiana S Chaves, Gilberto C Borges, Isabel C Werlang, Fernanda U Fontella, Ursula Matte, Marcelo Z Goldani, Paulo R Carvalho, Eliana A Trotta, Jefferson P Piva, Sergio G S Barros, Helena A S Goldani
BACKGROUND: Gastroesophageal reflux (GER) and pulmonary aspiration are frequent in patients in the ICU. The presence of pepsin in airways seems to be the link between them. However, pepsin isoforms A (gastric specific) and C (pneumocyte potentially derived) need to be distinguished. This study aimed to evaluate GER patterns and to determine the presence of pepsin A and C in tracheal secretions of critically ill children receiving mechanical ventilation. METHODS: All patients underwent combined multichannel intraluminal impedance-pH (MII-pH) monitoring...
August 2015: Chest
https://www.readbyqxmd.com/read/25650493/gastric-reflux-association-with-aspiration-and-oral-secretion-ph-as-marker-of-reflux-a-descriptive-correlational-study
#19
Marilyn Schallom, James A Orr, Norma Metheny, John Kirby, Janet Pierce
BACKGROUND: Gastric reflux leading to pulmonary aspiration is a frequent event in mechanically ventilated, gastric-fed patients, which can lead to ventilator-associated complications and pneumonia. OBJECTIVES: The objectives of this study were to determine the association between gastric reflux and aspiration using the presence of pepsin in oral or tracheal secretions as a marker of reflux or aspiration and to determine the association between the pH (range, 0-14) and the presence of pepsin in oral secretions...
March 2015: Dimensions of Critical Care Nursing: DCCN
https://www.readbyqxmd.com/read/25633964/the-role-of-gastric-pepsin-in-the-inflammatory-cascade-of-pediatric-otitis-media
#20
Robert C O'Reilly, Sam Soundar, Dalal Tonb, Laura Bolling, Estelle Yoo, Tracey Nadal, Christopher Grindle, Erin Field, Zhaoping He
IMPORTANCE: Otitis media is characterized as an ongoing inflammation with accumulation of an effusion in the middle ear cleft. The molecular mechanisms underlying the pathogenesis, particularly the inflammatory response, remain largely unknown. We hypothesize that aspiration of gastric contents into the nasopharynx may be responsible for the initiation of the inflammatory process or aggravate a preexisting condition. OBJECTIVE: To investigate the correlation of gastric pepsin A with inflammatory cytokines, bacterial infection, and clinical outcomes...
April 2015: JAMA Otolaryngology—Head & Neck Surgery
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