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Objective:To analyze the disease characteristics of aspiration pneumonia and its risk factors.Methods:In this retrospective case-control study, analysis was conducted on data from 92 patients aged ≥ 60 years admitted to Beijing Jishuitan Hospital, Capital Medical University between June 1, 2018 and July 31, 2022, with aspiration pneumonia(AsP) as the primary diagnosis at the time of hospital discharge and from non-AsP patients admitted during the same period.The number of participants was matched at a 1∶1 ratio.Results:The average age of the AsP group was(80.88 ± 9.41) years and 57(62.0%) were men.The average age of the control group was(77.74 ± 10.98) years and 52(56.5%) were men.There was no statistically significant difference in age and sex ratio(age: t=1.973, P=0.060; sex ratio: χ2=0.661, P=0.416).Univariate analysis showed that, at admission, body mass index(BMI) and activities of daily living(ADL) scores of the AsP group were lower than those of the non-AsP group, the proportions of patients with gastroesophageal reflux disease, acute trauma, cerebrovascular disease, history of cerebral infarction/hemorrhage and sequelae of cerebrovascular disease were higher than those of the non-AsP group(all P<0.05), and the proportions of patients receiving feeding via indwelling nasogastric intubation and tracheal intubation were also higher in the AsP group(all P<0.05).The white blood cell count, the percentage of neutrophils and the procalcitonin level in the first round of tests were higher in the AsP group than those in the non-AsP group and the maximum values of the above parameters during hospitalization were also higher than those in non-AsP patients, while the levels of albumin and prealbumin were lower than those in the non-AsP group( P<0.05 for all).Chest CT showed that 83.7%(77/92) of patients with AsP had bilateral pneumonia, higher than 55.4%(51/92) in the non-AsP group( χ2=8.569, P=0.014).Multivariate Logistic regression analysis showed that male sex( OR=16.206, 95% CI: 1.268-207.191, P=0.032) was a risk factor for AsP, and BMI( OR=0.747, 95% CI: 0.582-0.959, P=0.022) and ADL score at admission( OR=0.945, 95% CI: 0.903-0.988, P=0.014) were protective factors against AsP.ADL score at admission( OR=0.951, 95% CI: 0.907-0.982, P=0.043), tumor history( OR=6.859, 95% CI: 1.484-31.700, P=0.014), history of cerebral infarction/intracerebral hemorrhage( OR=4.368, 95% CI: 1.087-17.511, P=0.038), history of chronic renal insufficiency( OR=5.820, 95% CI: 1.445-23.440, P=0.013), acute respiratory failure( OR=5.281, 95% CI: 1.237-22.545, P=0.013) and myocardial infarction( OR=9.466, 95% CI: 2.151-41.660, P=0.003) were independent factors affecting the prognosis of pneumonia in the elderly. Conclusions:Aspiration pneumonia in the elderly is more common in men and in individuals with low BMI and low ADL scores.There is no increased risk of mortality in people with AsP, compared with people without AsP, but some risk factors in AsP patients may lead to poor prognosis, calling for increased awareness and early intervention in clinical practice.

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RESUMO Objetivo O objetivo deste estudo foi validar, com base nos processos de resposta, o Instrumento Multiprofissional de Rastreio para o Risco de Broncoaspiração em Ambiente Hospitalar, direcionado à população idosa. Método O instrumento foi aplicado por juízes em pacientes distintos e selecionados de forma aleatória. Após a aplicação, os juízes foram entrevistados para que fosse possível verificar a impressão deles quanto à relevância dos itens e quanto a interpretação sobre o conteúdo escrito, bem como a questões gramaticais e semânticas. Foram consideradas sugestões de acréscimo de alternativas de perguntas e de respostas, além de propostas de adequação de questões que compunham o instrumento. As reações não verbais, tais como expressões faciais que sugeriram dúvidas ou hesitações, por parte dos juízes, em relação ao instrumento, também foram analisadas. Resultados A concordância dos juízes em relação a cada item do dispositivo foi calculada pelo Índice de Validade de Conteúdo (IVC), e pelo Coeficiente de Correlação Intraclasse (CCI), sendo que seus resultados demonstraram alto nível de concordância. Através das sugestões dos juízes, elaborou-se uma nova versão do Instrumento Multiprofissional de Rastreio para o Risco de Broncoaspiração em Ambiente Hospitalar à população idosa. Conclusão Os resultados obtidos demonstraram que a validade do Instrumento Multiprofissional para Rastreio do Risco de Broncoaspiração em Ambiente Hospitalar junto à população idosa, baseada nos processos de respostas, foi alcançada.

ABSTRACT Purpose The objective of this study was to validate the Multiprofessional Screening Instrument for Broncho-aspiration Risk in Hospital Environment, which is aimed at the elderly population, based on response processes. Methods Judges applied the instrument to different patients and randomly selected. After the application, the judges were interviewed so that it was possible to verify their impression regarding the relevance of the items about their interpretation of the written content, as well as grammatical and semantic issues. Suggestions for adding alternative questions and answers were considered, as well as proposals for adapting the questions that made up the instrument. Non-verbal reactions, such as facial expressions that suggested doubts or hesitations, by the judges concerning the instrument were also analyzed. Results The agreement of the judges concerning each item of the device was calculated by the Content Validity Index (CVI) and by the Intraclass Correlation Coefficient (ICC), and their results showed a high level of agreement. Through the suggestions of the judges, a new version of the Multi-professional Screening Instrument for the Risk of Broncho-aspiration in a Hospital Environment in the Elderly was elaborated. Conclusion The results obtained showed that the validity of the Multi-professional Instrument for Screening the Risk of Broncho-aspiration in the Hospital Environment with the elderly population, based on the response processes, was achieved and makes it a promising device to assist professionals in hospital care for the elderly.

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ABSTRACT Objective: To evaluate the combined impact of videofluoroscopic swallow study (VFSS) and therapeutic feeding and swallowing interventions on clinical outcomes in children with oropharyngeal dysphagia (OPD). Methods: This was an uncontrolled longitudinal analytical study in which OPD patients were evaluated before and after VFSS. Children ≤ 24 months of age diagnosed with OPD in a clinical setting and undergoing VFSS for investigation and management of OPD were included in the study. The study participants received therapeutic feeding and swallowing interventions after having undergone VFSS, being followed at an outpatient clinic for pediatric dysphagia in order to monitor feeding and swallowing difficulties. Respiratory and feeding outcomes were compared before and after VFSS. Results: Penetration/aspiration events were observed in 61% of the VFSSs (n = 72), and therapeutic feeding and swallowing interventions were recommended for 97% of the study participants. After the VFSS, there was a reduction in the odds of receiving antibiotic therapy (OR = 0.007) and in the duration of antibiotic therapy (p = 0.014), as well as in the odds of being admitted to hospital (p = 0.024) and in the length of hospital stay (p = 0.025). A combination of oral and enteral feeding became more common than oral or enteral feeding alone (p = 0.002). Conclusions: A high proportion of participants exhibited penetration/aspiration on VFSS. Therapeutic feeding and swallowing interventions following a VFSS appear to be associated with reduced respiratory morbidity in this population.

RESUMO Objetivo: Avaliar o impacto conjunto da videofluoroscopia da deglutição (VFD) e intervenções terapêuticas de alimentação e deglutição nos desfechos clínicos em crianças com disfagia orofaríngea (DOF). Métodos: Trata-se de um estudo analítico longitudinal não controlado em que pacientes com DOF foram avaliados antes e depois da VFD. Foram incluídas no estudo crianças com idade ≤ 24 meses e diagnóstico clínico de DOF, submetidas à VFD para a investigação e manejo da DOF. Os participantes do estudo receberam intervenções terapêuticas de alimentação e deglutição após terem sido submetidos à VFD, sendo então acompanhados em um ambulatório de disfagia pediátrica para o monitoramento das dificuldades de alimentação e deglutição. Os desfechos respiratórios e alimentares foram comparados antes e depois da VFD. Resultados: Eventos de penetração/aspiração foram observados em 61% das VFD (n = 72), e intervenções terapêuticas de alimentação e deglutição foram recomendadas a 97% dos participantes do estudo. Após a VFD, houve uma redução das chances de receber antibioticoterapia (OR = 0,007) e da duração da antibioticoterapia (p = 0,014), bem como das chances de internação hospitalar (p = 0,024) e do tempo de internação (p = 0,025). A alimentação por via oral e enteral em conjunto tornou-se mais comum do que a alimentação exclusivamente por via oral ou enteral (p = 0,002). Conclusões: Houve alta proporção de crianças que apresentaram penetração/aspiração na VFD. As intervenções terapêuticas de alimentação e deglutição após a VFD parecem estar associadas à redução da morbidade respiratória nessa população.

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ABSTRACT Pulmonary aspiration of gastric residues during anesthesia is a potentially fatal complication for which no specific treatment is available. The primary way to prevent its occurrence in the context of elective surgeries is adherence to fasting protocols. However, some clinical conditions can prolong the gastric emptying time, and the risk of aspiration may exist despite adequate fasting. Recognizing the risk factors for gastroparesis allows the adoption of preventive methods and is the primary way to reduce morbidity and mortality from pulmonary aspiration. In this scenario, the anesthesiologist can investigate the gastric content by using ultrasound, adjust the anesthetic technique, and even postpone elective surgeries. Here, we describe incidental computed tomography finding of solid contents in the stomach of a patient without prior identification of the risk factors for gastroparesis. The patient underwent elective renal nodule ablation under general anesthesia after fasting for 9 hours. During the procedure, solid contents in the stomach were noted on computed tomography. Subsequently, it was discovered that the patient had been using semaglutide for 6 days and had not disclosed this information. Semaglutide use may represent a new and significant risk factor for anesthesia-related pulmonary aspiration. Until studies provide information on the appropriate perioperative management of patients using semaglutide, anesthesiologists need to adopt preventive measures to avoid aspiration. Awareness of this potential association and open communication among patients, physicians, and anesthesia teams are essential for enhancing patient safety.

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BACKGROUND: Intraoperative pulmonary aspiration is a rare but potentially fatal complication associated with various risk factors. Preoperative recognition of these risk factors can prevent aspiration events during general anesthesia or facilitate prompt corrective measures in patients experiencing this complication. CASE: A 70-year-old female patient with hypertension underwent bilateral total knee arthroplasty under general anesthesia. Despite using a midnight nothing-per-oral (NPO) protocol, an unpredictable intraoperative aspiration event occurred during anesthesia induction. A detailed evaluation of the patient's medical history and subsequent diagnostic imaging examinations indicated achalasia. She was treated for aspiration pneumonia for 2 weeks. After 2 months, rescheduled total knee arthroplasty was performed under spinal anesthesia without any complications. CONCLUSIONS: Obtaining the patient's medical history and assessing the risk factors are important to prevent unpredictable intraoperative pulmonary aspiration. High-risk patients should undergo adequate preoperative fasting and regional anesthesia or rapid-sequence intubation should be considered for safe induction of general anesthesia.

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Dysphagia is the common complication of stroke. It is difficult for patients with dysphagia to eat, and they are prone to develop choking, aspiration, malnutrition, and even aspiration pneumonia, leading to death. The body's nervous system has greater plasticity in the relatively short period after stroke. Active treatment and rehabilitation care can promote the recovery of the damaged nervous system and improve the swallowing function of patients with dysphagia after stroke. At present, there are many rehabilitation nursing interventions for stroke patients with dysphagia. This paper reviews the research progress of rehabilitation nursing interventions for stroke patients with dysphagia at home and abroad, from the perspectives of swallowing evaluation, basic training, feeding training, and complication prevention, so as to provide evidence for clinical rehabilitation nursing.

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ABSTRACT Objective: adapt and validate the Barnes-Jewish Hospital-Stroke Dysphagia Screen (BJH-SDS) instrument to European Portuguese speakers. Method:BJH-SDS underwent a rigorous process of cross-cultural adaptation and was validated with acute stroke patients in five stroke units from February 2018 to April 2019. For data analysis, SPSS 25 was used. Nurses performed the screening on admission, and inter-rater reliability was established. Results of clinical bedside evaluation were compared with those provided by BJH-SDS. Results: cross-cultural adaptation was performed and completed successfully without difficulties. For validation, 226 acute stroke patients were enrolled. The incidence of dysphagia using BJH-SDS was 72.1%, and a highly significant relationship (χ2 = 87.81; p <0.001) was observed compared to clinical bedside evaluation, with an area under the ROC curve of 0,765. Excellent inter-rater reliability (k=0.977) was reached.Conclusion: results suggest that the Portuguese version of the BJH-SDS is a reliable dysphagia screening test. It is straightforward to be administered bedside by nurses with minimal training required. It was also shown to have adequate sensitivity to assist in decision-making to refer stroke patients for a more comprehensive evaluation.

RESUMEN Objetivo: adaptar y validar el Barnes-Jewish Hospital-Stroke Dysphagia Screen (BJH-SDS) para portugués de Portugal. Método: se realizó un riguroso proceso de adaptación transcultural y validación con pacientes con accidente cerebrovascular agudo en cinco hospitales entre febrero de 2018 y abril de 2019. El análisis de datos se realizó con SPSS 25. El cribado fue realizado por enfermeras. Los resultados de la evaluación clínica a pie de cama se compararon con los de BJH-SDS. Resultados: se realizó la adaptación transcultural y completado con éxito sin dificultades. Para la validación, se incluyeron 226 pacientes. La incidencia de disfagia por BJH-SDS fue del 72,1% y se observó una relación muy significativa con la evaluación clínica a pie de cama (χ2 = 81,87; p <0,001), un área bajo la curva ROC de 0,765. La fiabilidad entreexaminadores fue excelente (k = 0,977). Conclusión: los resultados sugieren que la versión portuguesa de la BJH-SDS es una prueba de detección fiable para la disfagia. Es fácil y simple de usar junto a la cama por parte de enfermeras con una formación mínima requerida. Mostró una sensibilidad adecuada para ayudar en la toma de decisiones para derivar a estos pacientes para una evaluación más completa.

RESUMO Objetivo:adaptar e validar o Barnes-Jewish Hospital-Stroke Dysphagia Screen (BJH-SDS) para o português de Portugal. Método:realizado um rigoroso processo de adaptação transcultural e validação com pacientes com acidente vascular cerebral agudo em cinco hospitais entre fevereiro de 2018 e abril de 2019. A análise dos dados foi realizada com SPSS 25. O rastreio foi realizado por enfermeiras na admissão. Os resultados da avaliação clínica à beira do leito foram comparados com os fornecidos pelo BJH-SDS. Resultados:a adaptação transcultural foi realizada e completada com sucesso sem dificuldades. Para validação, 226 pacientes foram incluídos. A incidência de disfagia pelo BJH-SDS foi de 72,1% e uma relação altamente significativa foi observada quando comparada aos resultados da avaliação clínica à beira do leito (χ2 = 81,87; p <0,001), com uma área abaixo da curva ROC de 0,765. A confiabilidade inter examinador alcançada foi excelente (k = 0,977). Conclusão:os resultados sugerem que a versão portuguesa do BJH-SDS é um teste de rastreio da disfagia confiável. É de utilização fácil e simples à beira do leito por enfermeiras com mínimo de treinamento necessário. Demonstrou ter sensibilidade adequada para auxiliar na tomada de decisão de encaminhar estes pacientes para uma avaliação mais abrangente

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El talco, un silicato de magnesio hidratado, formó parte durante décadas del cuidado tradicional de lactantes y niños pequeños. Si bien en los niños su inhalación aguda, que suele ser accidental durante el cambio de pañales, no es frecuente, es una condición potencialmente peligrosa, que puede provocar dificultad respiratoria grave e incluso cuadros mortales. Se describe el grave compromiso respiratorio por neumonitis química asociado con la inhalación accidental de talco en un lactante de 14 meses. El niño presentó un cuadro de dificultad respiratoria con requerimiento de asistencia respiratoria mecánica (ARM) durante una semana. En cuanto al tratamiento, no existe un estándar, se utilizaron antibióticos y corticoides sistémicos y aerosolterapia. No presentó complicaciones en otros órganos o sistemas. Su evolución fue favorable, se pudo externar al décimo día de internación y presentó posteriormente episodios aislados de hiperreactividad bronquial.

Talc is a hydrated magnesium silicate. It was part of traditional infant and young child care for decades. In children, its acute inhalation, generally accidental during diaper changes, although not frequent, is a potentially dangerous condition, and can cause severe respiratory distress and even death. We describe the case of a 14-month child who had an accidental inhalation of talc, chemical pneumonitis and severe respiratory compromise. The patient had acute respiratory distress syndrome requiring mechanical ventilation for one week. There is no standard treatment, we used systemic antibiotics and corticosteroids and aerosol therapy. He did not have complications in other organs or systems. He was hospitalized for ten days. In the follow up, he had isolated episodes of bronchial hyperresponsiveness.

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Talc is a hydrated magnesium silicate. It was part of traditional infant and young child care for decades. In children, its acute inhalation, generally accidental during diaper changes, although not frequent, is a potentially dangerous condition, and can cause severe respiratory distress and even death. We describe the case of a 14-month child who had an accidental inhalation of talc, chemical pneumonitis and severe respiratory compromise. The patient had acute respiratory distress syndrome requiring mechanical ventilation for one week. There is no standard treatment, we used systemic antibiotics and corticosteroids and aerosol therapy. He did not have complications in other organs or systems. He was hospitalized for ten days. In the follow up, he had isolated episodes of bronchial hyperresponsiveness.

El talco, un silicato de magnesio hidratado, formó parte durante décadas del cuidado tradicional de lactantes y niños pequeños. Si bien en los niños su inhalación aguda, que suele ser accidental durante el cambio de pañales, no es frecuente, es una condición potencialmente peligrosa, que puede provocar dificultad respiratoria grave e incluso cuadros mortales. Se describe el grave compromiso respiratorio por neumonitis química asociado con la inhalación accidental de talco en un lactante de 14 meses. El niño presentó un cuadro de dificultad respiratoria con requerimiento de asistencia respiratoria mecánica (ARM) durante una semana. En cuanto al tratamiento, no existe un estándar, se utilizaron antibióticos y corticoides sistémicos y aerosolterapia. No presentó complicaciones en otros órganos o sistemas. Su evolución fue favorable, se pudo externar al décimo día de internación y presentó posteriormente episodios aislados de hiperreactividad bronquial.

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OBJECTIVE: To investigate the association between the Simple Swallowing Provocation Test (SSPT) and the incidence of aspiration pneumonia in patients with dysphagia in long-term care (LTC) wards. DESIGN: The study design was a prospective cohort study. Participants were followed for 60 days from admission. SETTING: LTC wards. PARTICIPANTS: Study participants were patients with dysphagia aged ≥65 years who were admitted to LTC wards between August 2018 and August 2019. In total, 39 participants were included in the analysis (N=39; 20 male, 19 female; mean age, 83.8±8.5y). Participants were divided into 2 groups based on SSPT results: normal swallowing reflex (SSPT normal group) and abnormal swallowing reflex (SSPT abnormal group). The covariates were age and sex, primary disease, history of cerebrovascular disease, Glasgow Coma Scale, body mass index, Geriatric Nutritional Risk Index, the Mann Assessment of Swallowing Ability, Food Intake Level Scale, FIM, and Oral Health Assessment Tool. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The outcome was the incidence of aspiration pneumonia during the first 60 days of hospitalization, and the predictive factor was SSPT: 0.4 mL. RESULTS: The incidence of aspiration pneumonia was 33.3% in the SSPT normal group and 76.2% in the SSPT abnormal group. The φ coefficient (a measure of association for 2 binary variables) was 0.43, the risk ratio (the ratio of the probability of an outcome in an exposed group to the probability of an outcome in an unexposed group) was 2.29, and the 95% confidence interval was 1.14-4.58 for the SSPT abnormal group. CONCLUSIONS: Our findings suggest that the SSPT provides a valid index for the development of aspiration pneumonia in older patients with dysphagia admitted to LTC wards.

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INTRODUCTION: When a patient treated by immune checkpoint inhibitors for metastatic melanoma presents with pulmonary symptoms, several diagnoses are possible. We report a case of acute granulomatous lung disease secondary to repeated kayexalate inhalations, and probably stimulated by immunotherapy. CASE REPORT: A patient treated with pembrolizumab and then ipilimumab presented with fever and acute shortness of breath. His pulmonary symptoms got progressively worse, leading to an acute respiratory distress syndrome. Chest CT displayed a pattern of non-specific organized pneumonia. Pulmonary infection, tumor progression, specific immune-related lung toxicity and immunotherapy-induced sarcoidosis were discussed. Histopathological examination of a lung biopsy showed a foreign body granulomatous macrophage reaction associated with crystalline, basophilic, purple and laminated elements, evoking kayexalate particles. These elements helped rewrite the diagnosis and confirmed a kayexalate-induced granulomatous lung disease secondary to repeated aspiration. The patient's respiratory condition got better following discontinuation of kayexalate together with systemic corticosteroids. Symptoms relapsed with resumption of the immunotherapy but were controlled with the addition of a new course of prolonged systemic corticosteroid therapy. We can hypothesize that immunotherapy played a role in the recurrence of the granulomatous lung reaction, or that there was an association between an aspiration pneumonia and an immunotherapy-induced lung toxicity. CONCLUSION: Facing respiratory symptoms during immunotherapy, the treatment may be the cause, but lung biopsy should be performed rapidly to arrive to a certain diagnosis.

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OBJECTIVES: To assess the healthcare costs associated with poststroke oropharyngeal dysphagia (OD) and its complications (malnutrition, dehydration, pneumonia and death). DESIGN: Systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations. DATA SOURCES: MEDLINE, Embase and the National Health Service Economic Evaluation Database were searched up to 31 December 2019. PARTICIPANTS: Patients with poststroke. PRIMARY OUTCOME MEASURES: The costs associated to poststroke OD and its complications. DATA ANALYSIS: Data were synthetised narratively, quality evaluation was done using an adaptation of Drummond's checklist and Grading of Recommendations Assessment, Development and Evaluation recommendations were used to assess strength of evidence. RESULTS: A total of 166 articles were identified, of which 10 studies were included. The cost of OD during the hospitalisation was assessed in four studies. One prospective study showed an increase of US$6589 for patients requiring tube feeding. Two retrospective studies found higher costs for those patients who developed OD, (US$7329 vs US$5939) among patients with haemorrhagic stroke transferred to inpatient rehabilitation and an increase of €3000 (US$3950) and SFr14 000 (US$15 300) in hospitalisation costs. One study did not found OD as a predictor for total medical costs in the multivariate analysis. One retrospective study showed an increase of US$4510 during the first year after stroke for those patients with OD. For pneumonia, five retrospective studies showed an increase in hospitalisation costs after stroke of between US$1456 and US$27 633. One prospective study showed an increase in hospitalisation costs during 6 months after stroke in patients at high malnutrition risk. Strength of evidence was considered moderate for OD and pneumonia and low for malnutrition. CONCLUSIONS: This systematic review shows moderate evidence towards higher costs for those patients who developed OD after stroke. The available literature is heterogeneous, and some important aspects have not been studied yet. Further studies are needed to define the specific cost of poststroke OD. PROSPERO REGISTRATION NUMBER: CRD42018099977.

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Pneumonia and in particular aspiration pneumonia, is a common disease in geriatrics. These aspirations are often due to dysphagia, which is frequently first noticed in the context of a geriatric assessment. The reasons for dysphagia are manifold. In this geriatric department several patients have been detected in recent months in whom a Zenker diverticulum was the cause of recurrent aspiration pneumonia. The swallowing disorder was already apparent during the logopedic examination on admission to hospital. A supplementary fiber optic endoscopic evaluation of swallowing (FEES) revealed a postswallow hypopharyngeal reflux (PSHR), which is typical for a Zenker diverticulum. A supplementary contrast esophagography confirmed the findings. In the present case the treatment of choice was a myotomy with a flexible endoscope performed by gastroenterologists. After successful treatment, swallowing was again possible with no indications of penetration or aspiration in the FEES control. The case highlights the importance of logopedic diagnostics and treatment in geriatric patients with recurrent pneumonia. With the aid of early diagnostics it was possible to quickly recognize the finding of a PSHR that is typical for a Zenker diverticulum. The findings in this case could be clearly demonstrated based on the images of the FEES and contrast esophagography.

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ABSTRACT Purpose: to identify, in the clinical assessment of swallowing, signs indicating silent aspiration in ischemic stroke patients. Methods: forty-six patients were assessed, 17 days being the mean time elapsed from the stroke to the swallowing assessment. The clinical assessment encompassed structural and functional aspects, oximetry monitoring, and cervical auscultation. During the videofluoroscopy examination, the patients were also monitored with pulse oximetry. In both assessments, the patients were given 100 ml of liquid. In the statistical analysis, the exact logistic regression test and odds ratio calculation were used, with a 0.05 significance level. Results: seven, out of the 46 patients, presented aspiration, which was silent in six of them. Change in the cervical auscultation, in the clinical assessment (OR: 18.8; 95% CI: 1.2 - 1000, p = 0.03), was associated with silent aspiration, as detected in the videofluoroscopy. The hawking present in the analysis of the recording (OR: 12.2; 95% CI: 1.23 - ∞, p = 0.03), was associated with possible non-silent laryngotracheal penetrations and aspirations. No change was identified regarding oxygen saturation in patients presented with silent aspiration. Conclusion: the change in cervical auscultation observed in the clinical assessment can indicate silent aspiration in patients affected by an ischemic stroke.

RESUMO Objetivo: identificar sinais na avaliação clínica da deglutição que indiquem aspiração silente em pacientes com acidente vascular cerebral isquêmico. Métodos: foram avaliados 46 pacientes. O tempo médio entre a ocorrência do acidente e a avaliação da deglutição foi de 17 dias. A avaliação clínica abarcou aspectos estruturais e funcionais, monitoração da oximetria e ausculta cervical. Durante o exame de videofluoroscopia os pacientes foram monitorados por meio da oximetria de pulso. Em ambas avaliações os pacientes ingeriram 100 ml de líquido. Na análise estatística foi utilizado o teste de regressão logística exata e o cálculo do Odds Ratio (OR), com nível de significância de 0,05. Resultados: dos 46 pacientes, sete apresentaram aspiração, sendo silente em seis. A alteração da ausculta cervical na avaliação clínica (OR: 18,8; IC 95%: 1,2 - 1000, p=0,03) associou-se à aspiração silente detectada na videofluoroscopia. O pigarro presente na análise da filmagem (OR: 12,2; IC 95%: 1,23 - ∞, p=0,03) foi associado a possíveis penetrações e aspiração laringotraqueais não silentes. Não foi identificada alteração no nível de saturação de oxigênio nos pacientes com aspiração silente. Conclusão: alteração da ausculta cervical observada na avaliação clínica pode indicar aspiração silente em pacientes acometidos por acidente vascular cerebral isquêmico.

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Background The purpose of this study is to compare the rate of aspiration pneumonia and survival time of dogs undergoing two unilateral arytenoid lateralisation (UAL) techniques.Methods Eighty dogs diagnosed with laryngeal paralysis were treated by one of two UAL techniques: (1) a standard technique (ST) and (2) an anatomic preservation technique (APT). Outcome was assessed by in clinic re-examination and an owner follow-up questionnaire.Results Minor complications were reported for 22 per cent of dogs undergoing ST and 26 per cent for APT. Major complications were 7 per cent for ST versus 23 per cent for APT. Postoperative aspiration pneumonia was reported for 7 per cent of cases in ST and 17 per cent in APT. The median survival time for ST was 636 days and was 1067 days for APT. Cause of death was related to the laryngeal paralysis in 22 per cent, neurological deterioration in 16 per cent and for non-associated reasons in 59 per cent of cases. There was no statistically significant difference in the rate of aspiration pneumonia or survival time among the treatment groups. Owners reported that their dogs improved after both surgical procedures, with 90 per cent of the owners satisfied with the surgical outcome. Eighteen per cent of the dogs suffered recurrence of clinical signs.Conclusions In this study, there was no significant difference in risk of aspiration pneumonia or survival time following arytenoid lateralisation by either an ST or an APT.

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RESUMO Objetivo caracterizar e comparar os aspectos funcionais da deglutição e indicadores clínicos na população com traumatismo cranioencefálico (TCE) em unidade de terapia intensiva. Método Participaram do estudo 113 adultos com diagnóstico de TCE. As etapas de coleta de dados envolveram: a avaliação fonoaudiológica clínica do risco de broncoaspiração, determinação do nível funcional da deglutição (American Speech-Language-Hearing Association National Outcome Measurement System - ASHA NOMS), determinação da gravidade clínica do indivíduo de acordo com a Sequential Organ Failure Assessment (SOFA). Resultados Após a aplicação dos critérios de inclusão, os pacientes selecionados foram agrupados de acordo com os níveis funcionais de deglutição: níveis 1 e 2 - ASHA1 (n=25); níveis 3, 4 e 5 - ASHA2 (n=37); níveis 6 e 7 - ASHA3 (n=51). As análises estatísticas indicaram os seguintes resultados significantes: o grupo ASHA3 apresentou menor gravidade do TCE no momento da avaliação fonoaudiológica, menor tempo de intubação orotraqueal (um terço a menos que o grupo mais grave), ficou menos tempo hospitalizado e necessitou de menos sessões de atendimento fonoaudiológico para o retorno seguro para via oral de alimentação. Os sinais clínicos preditores de broncoaspiração que mais diferenciaram os grupos foi a presença de ausculta cervical alterada e presença de tosse após a deglutição, sendo que o grupo ASHA3 apresentou esses sinais com menor frequência. Conclusão O escore SOFA e o tempo de intubação orotraqueal foram indicadores do prognóstico da funcionalidade da deglutição. A presença ausculta cervical alterada e tosse foram preditores clínicos de disfagia.

ABSTRACT Purpose To characterize and compare the functional aspects of swallowing and clinical markers in intensive care patients with traumatic brain injury (TBI) in Intensive Care Unit (ICU). Methods Participants of this study were 113 adults diagnosed with TBI. Data collection stage involved: clinical assessment of the risk for bronchoaspiration performed by a speech-language therapist; assessment of the functional level of swallowing (American Speech-Language-Hearing Association National Outcome Measurement System - ASHA NOMS ); assessment of the patient' health status (Sequential Organ Failure Assessment - SOFA). Results After the inclusion criteria were applied, patients were grouped according to their swallowing functional level: levels 1 and 2 - ASHA1 (n=25); levels 3, 4 and 5 - ASHA2 (n=37); levels 6 and 7 - ASHA3 (n=51). The statistical analyses indicated the following significant results: the ASHA3 group presented lower severity levels of TBI at the clinical assessment of bronchoaspiration, remained less time intubated (approximately um third less than the more severe group), remained fewer days in hospital and needed less therapy sessions to return to safe oral feeding. The clinical predictor signs for bronchoaspiration that best characterized the groups were the presence of altered auscultation and the presence of coughing after swallowing. Patients in the ASHA3 group presented these signs less frequently. Conclusion The score obtained on the SOFA and the time of orotracheal intubation were identified as the prognostic indicators of functional swallowing. The presence of altered cervical auscultation and coughing were clinical predictors of dysphagia.

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ABSTRACT Objective: To determine the oral health conditions of the elderly patients hospitalized and restricted to the bed and to correlate with the development of infections at a distance, especially pneumonia. To verify if the daily follow-up of the dental surgeon improves oral health and reduces the occurrence of respiratory infection in hospitalized elderly patients. Methods: Quasi-experimental study with hospitalized and bed restricted elderly, two simple randomized groups, one group was evaluated and monitored daily by the dental surgeon, the other group was evaluated and received guidance on health care and oral hygiene and of dental prostheses. Results: Both groups presented poor health and oral hygiene and prosthetic conditions. There was improvement in the oral health conditions of both groups. Seven percent of the patients developed pneumonia during the period of hospital stay and the oral health of these patients were considered regular or bad. Conclusion: The performance of the dental surgeon promoted improvements in the oral health of both groups in the first evaluation, with no statistical difference between the group that received daily follow-up and the group that received guidelines, so it was concluded that oral health care should be a behavior of the team multidisciplinary, dentistry should intervene if the changes interfere in the clinical condition of the patient and offer training and support to the multidisciplinary team that is in the first line of care with hospitalized patients.

RESUMO Objetivo: Determinar as condições de saúde bucal dos pacientes idosos hospitalizados e restritos ao leito e correlacionar com o desenvolvimento de infecções à distância, sobretudo a pneumonia. Verificar se o acompanhamento diário do cirurgião-dentista melhora a saúde bucal e reduz a ocorrência de infecção respiratória em pacientes idosos internados. Metodologia: Estudo quase experimental com idosos internados em um hospital de ensino do sul do Brasil, restritos ao leito. A amostra teve 42 indivíduos, divididos em 2 grupos de formação aleatória simples, o grupo 1 recebeu avaliação e acompanhamento diário do cirurgião-dentista, o grupo 2 foi avaliado e recebeu orientações sobre os cuidados com a saúde e higiene bucal e das próteses dentárias. Resultados: Ambos os grupos apresentavam condições precárias da saúde e higiene bucal e das próteses na primeira avaliação. Houve melhora nas condições de saúde bucal de ambos os grupos no final da internação. Sete por cento dos pacientes desenvolveram pneumonia durante a internação hospitalar e a saúde bucal destes pacientes foram consideradas regulares ou ruins. Conclusão: A atuação do cirurgião-dentista promoveu melhoras na saúde bucal de ambos os grupos, sem diferença estatística entre o grupo que recebeu acompanhamento diário e o grupo que recebeu orientações, assim conclui-se que a atenção à saúde bucal deve ser uma conduta da equipe multidisciplinar, a odontologia deve estar presente para atuar em alterações que interfiram na condição clínica do paciente e oferecer capacitações e suporte para a equipe multidisciplinar que está na primeira linha de cuidados com os pacientes hospitalizados.

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INTRODUCTION: Oropharyngeal dysphagia (OD) is a major disorder following stroke. OD can produce alterations in both the efficacy and safety of deglutition and may result in malnutrition, dehydration, frailty, respiratory infections and pneumonia. These complications can be avoided by early detection and treatment of OD in poststroke patients, and hospital stays, medication and mortality rates can be reduced. In addition to acute in-hospital costs from OD complications, there are other costs related to poststroke OD such as direct non-healthcare costs or indirect costs. The objective of this systematic review is to assess and summarise literature on the costs related to OD in poststroke patients. METHODS AND ANALYSIS: A systematic review of studies on the cost of OD and its complications (aspiration, malnutrition, dehydration, aspiration pneumonia and death) in patients who had a stroke will be performed from the perspectives of the hospital, the healthcare system and/or the society. The main outcomes of interest are the costs related to poststroke OD. We will search MEDLINE, Embase and the National Health Service Economic Evaluation Database. Studies will be included if they are partial economic evaluation studies, studies that provide information on costs in adult (>17 years) poststroke patients with OD and/or its complications (malnutrition, dehydration, frailty, respiratory infections and pneumonia) or economic evaluation studies in which the cost of this condition has been estimated. Studies will be excluded if they refer to oesophageal dysphagia or OD caused by causes other than stroke. Main study information will be presented and summarised in tables, separately for studies that provide incremental costs attributable to OD or its complications and studies that report the effect of OD or its complications on total costs of stroke, and according to the perspective from which costs were measured. ETHICS AND DISSEMINATION: The results of this systematic review will be published in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER: CRD42018099977.

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Laryngeal clefts as exceptionally rare congenital anomalies have been reported more and more recently. The clinical symptoms and presentations base on degree of clefts and variety of comorbidities. Mild types of clefts may have minimal clinical impact, whereas severe types may be life-threatening and even lead to death before diagnosis. With more attention of these anomalies and advances in endoscopy, the diagnosis, evaluation and surgery of laryngeal clefts have acquired great improvement, especially International Pediatric Otolaryngology Group(IPOG)have reported consensus guidelines on the diagnosis and management of type Ⅰ laryngeal clefts in 2017. This review of laryngeal clefts may be beneficial to decrease missed diagnosis or misdiagnosis and to achieve individual-based treatment.

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ABSTRACT Objective: to manage the risk of bronchoaspiration in patients with oropharyngeal dysphagia through signalizing plates in the hospital bed. Methods: a descriptive, quantitative study, developed in the medical clinic I (diagnostic investigation), medical clinic II (infectology / pneumology), surgical clinics and intensive care unit of the University Hospital of the Federal University of Sergipe, from February to August 2017. It was composed of patients in the age group ≥ 18 years of age, of both sexes, diagnosed with oropharyngeal dysphagia, based on the application of the adapted protocol of clinical evaluation in the hospital bed and instrumental examination of swallowing, when pertinent. Following the clinical evaluation and identification of the risk of bronchoaspiration due to oropharyngeal dysphagia, the signs were inserted at the hospital bed by the speech therapist. Results: the study included 43 patients at risk of bronchoaspiration due to oropharyngeal dysphagia, average age of 53.7 ± 3.53 years old, with 51.1% (n = 22) females and 48.9% (n = 21) males. A predominance of neuropathies (53.4%) and severe neurogenic oropharyngeal dysphagia (37.2%) was observed. The intensive care unit stood out with 44.18% (n = 19) of the application of signs of risk of bronchoaspiration. Conclusion: the management of bronchoaspiration risk has been shown to be a promising measure to reduce adverse events, which affect the patient's safety and consequently the quality of care in the hospital environment, as well as a possible strategy for measuring respiratory complications triggered by aspiration of oropharyngeal contents.

RESUMO Objetivo: gerenciar o risco de broncoaspiração em pacientes com disfagia orofaríngea por meio de placas sinalizadoras no leito. Métodos: estudo descritivo, transversal, de caráter quantitativo, desenvolvido na clínica médica I, clínica médica II, clínica cirúrgica e unidade de terapia intensiva do Hospital Universitário da Universidade Federal de Sergipe, de fevereiro a agosto de 2017. Composto por pacientes na faixa etária ≥ 18 anos de idade, ambos os sexos, com disfagia orofaríngea, baseada na aplicação do Protocolo Adaptado de Avaliação Clínica no Leito e exame instrumental da deglutição. Subsequente à avaliação clínica e identificação do risco de broncoaspiração por disfagia orofaríngea, o profissional fonoaudiólogo realizou a inserção da placa sinalizadora junto ao leito. Resultados: abrangeu 43 pacientes com risco de broncoaspiração por disfagia orofaríngea, média de idade 53,7± 3,53 anos, sendo 51,1% (n=22) do sexo feminino e 48,9% (n=21) do sexo masculino. Observou-se predomínio de neuropatias (53,4%) e de disfagia orofaríngea neurogênica grave (37,2%). A unidade de terapia intensiva destacou-se com 44,18% (n= 19) de aplicação das placas sinalizadoras. Conclusão: o gerenciamento do risco de broncoaspiração demonstrou ser uma medida promissora para redução de eventos adversos, os quais afetam a segurança do paciente e a qualidade do cuidado no ambiente hospitalar.