Increased incidence of nosocomial pneumonia in mechanically ventilated patients with subclinical aspiration
Article Abstract:
It is a very serious problem when an intubated patient develops pneumonia. This nosocomial pneumonia (hospital-acquired lung inflammation) may develop in from 20 to 25 percent of patients treated in the intensive care unit who are intubated (receiving mechanical ventilation, or assisted breathing); over half of these patients will die from the pneumonia. Aspiration of stomach contents into the lungs in tube-fed patients is thought to be a factor that contributes to development of pneumonia. These patients have lowered respiratory defenses and an overgrowth of bacteria in the stomach; both conditions contribute to the severe results when even a small amount of stomach contents is aspirated into the lungs. It is difficult to tell when aspiration of the tube feeding solution occurs; the aspiration may be ongoing or may be occurring at a very low level. A study was undertaken to determine if there is a significant relationship between subclinical aspiration and development of pneumonia in patients receiving tube feedings in which the tube is inserted through the nose and down into the stomach. Twenty-four ventilated patients receiving tube feedings were studied. The presence of glucose (sugar) in the fluid removed from the respiratory tract indicated aspiration of the stomach contents. Twelve patients had no glucose identified in their respiratory tract fluid; the other 12 had from one to five positive tests for glucose. Seven patients had bloody glucose-positive respiratory fluid; four developed pneumonia. Five patients had non-bloody glucose-positive respiratory fluid; all developed pneumonia. The presence of non-bloody, glucose-positive respiratory tract secretions was 100 percent predictive of the development of pneumonia. The predictive value of only a positive glucose test (regardless of whether blood was present) was 75 percent. It is concluded that subclinical amounts of stomach contents aspirated into the lungs contribute to the development of nosocomial pneumonia. It is suggested that intubated patients who are being tube fed be tested twice daily for the presence of glucose in the respiratory tract secretions. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Surgery
Subject: Health
ISSN: 0002-9610
Year: 1991
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In vitro and in vivo evaluation of intraluminal ultrasound in normal and atherosclerotic arteries
Article Abstract:
Atherosclerosis, cholesterol plaque formation on the inner layer of the artery wall, can vary from asymptomatic vessel wall thickening to complete occlusion of the artery. Plaques can progress without narrowing of the lumen (the space within the vessel) because the artery can compensate for the narrowing by dilating. The definitive technique for studying arteries and detecting obstruction is angiography. However, this X-ray examination of the blood vessels following injection of radio-opaque contrast dye does not reveal thickening of the wall of the artery. The use of ultrasound (imaging of structures by measuring and recording the reflection of sound waves) is often limited by poor quality images. A report is presented of results obtained using ultrasound with a rotating transducer on the tip of a probe placed within the lumen of the artery. The accuracy of this method in determining the dimensions and morphology (physical shape and size) of normal and diseased arteries was evaluated. A laboratory study compared ultrasound images of human arteries (nine with atherosclerosis and eight that were normal) with the microscopic slides of the arteries. A significant correlation was found between both normal and diseased arteries for lumen diameter, adventitial diameters, and arterial wall thickness; the strongest correlation was for diameter of the lumen. Studies were also carried out with dogs, comparing luminal dimensions obtained using ultrasound images with those obtained using angiography. These results correlated significantly for both normal and atherosclerotic vessels. It is concluded that this technique is accurate and may be valuable as a guide for devices used in vascular reconstructive surgery. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Surgery
Subject: Health
ISSN: 0002-9610
Year: 1990
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