Satisfaction of Patients Treated Surgically for Intractable Aspiration: Data CollectionData Collection
The following clinical data concerning the surgical procedure were examined: operation time, time until oral intake, videoflu-orographic study, and surgical complications. The medical management for aspiration including feeding condition was also examined before and after surgery. Scores of aspiration pneumonia, BMI, laboratory data, the Barthel Index, the SDS, the face scale, and the VAS were determined 1 month before surgery and again 14.5 ± 6.7 months (range, 8 to 25 months) after surgery. All patients were clinically stable 1 month before surgery and did not suffer from respiratory failure caused by pneumonia. In addition, the SDS, the face scale, and the VAS of families were evaluated before and after surgery. Read the rest of this entry »

Seven patients with intractable aspiration and recurrent aspiration pneumonia participated in this study. We confirmed the aspirations by videofluorography and clinical evaluation in all patients. The indications for surgical therapy for intractable aspiration are as follows: (1) aspiration cannot be controlled by medical treatments; (2) there is an irreversible laryngeal dysfunction; (3) phonation disturbance is aphonia or unintelligible speech; (4) there are no other diseases with a poor prognosis, such as end-stage malignancies; (5) prognosis would improve if aspiration was completely prevented; (6) informed consent is provided agreeing to loss of speech; (7) there is a desire to be able to eat orally and taste food; and (8) there is no contraindication for general anesthesia. All of our patients fulfilled these criteria. These studies were approved by the Institutional Review Board of Kumamoto University. Read the rest of this entry »

Satisfaction of Patients Treated Surgically for Intractable AspirationAspiration is a major cause of pulmonary infections, and recurrent aspiration can cause life-threatening pulmonary diseases. Swallowing difficulties resulting in aspiration occur in a variety of swallowing and laryngeal dysfunctions associated with neuromuscular, esophageal, and laryngeal dis-orders. Management of patients with aspiration initially requires discontinuation of oral intake. In some instances, pulmonary lavage may be indicated, Next, alimentary routes are changed to enteral routes requiring nasogastric tube feeding (NTF) and gastrostomy, or IV hyperalimentation (IVH). In addition, antimicrobial therapy may be necessary to counteract bacterial infections. natural inhalers for asthma
These medical managements are ordinarily effective; however, in some patients, intractable aspiration and aspiration pneumonia necessitate surgical procedures, mainly laryngectomy or laryngotracheal separation. Although these procedures separate the airway and digestive systems and can effectively eliminate intractable aspiration, patients who undergo these therapies lose the ability to speak after surgery. To determine the efficacy of surgical therapy, we examined changes in medical management, including feeding conditions, and clinical data of patients who underwent surgery. Moreover, because it is unclear whether such patients and their families are truly satisfied with surgical therapy, we also investigated whether depression levels and mood of patients and families changed after surgery. In this article, we show that the surgical therapy for intractable aspiration improves at least some variables of quality of life including feeding conditions and clinical data. In addition, we show that this therapy also improves the depression and mood of both patients and families.

Consequently, the final outcome was adjusted for all patients during the first week. In class III, as previously discussed, the initial prognostic classification was always correct. Moreover, for 15 patients, the occurrence of complications worsened the estimated prognosis. Most of them (14/15) occurred during the first week of the ICU stay. The final outcome was, thus, adjusted within the first week of ICU stay for 98.5% of patients. For the remaining patients in class II, the prognosis on ICU admission appeared imprecise and depended on the occurrence vs the nonoccurrence of complications during the ICU stay. In our analysis, we were unable to identify, on ICU admission, the predictive factors of complications occurring during the ICU stay. Read the rest of this entry »

Simplified Prediction Rule for Prognosis of Patients With Severe Community-Acquired Pneumonia in ICUs: OutcomeOur results suggest some additional comments. First, the incidence of complications occurring during the ICU stay appeared quite different according to the initial severity of infection and/or underlying diseases: from class I to class III, we observed a significantly increased occurrence of HA-LRT superinfections, nonspecific CAP-related complications, and sepsis-related complications. Second, if the prognostic impact of HA-LRT superinfections was quite similar in the three initial risk classes, the mortality rates associated with the occurrence of nonspecific CAP-related and sepsis-related complications appeared significantly increased from class I to class III. Finally, the influence of the initial risk score on ICU admission should be mentioned. As the estimated risk of mortality for a patient with a low score was weak, admission into an ICU could be questionable. However, some factors, such as neurologic or neuromuscular disturbances, were not studied and the use of such an index to withhold ICU admission could therefore be improper. buy-asthma-inhalers-online
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Attention is drawn to the apparently wide differences between initial estimated mortality risk and final outcome. After evaluation with initial predictors of mortality and establishment of the initial risk score, 153 patients were in the low-risk class I. The overall estimated mortality rate in this class was 4%. Among these patients, 145 (95%) exhibited an adjustment score < 2, and only 2 patients (1.4%) died. Such data suggest that classification into a low-risk class, after initial evaluation on ICU admission, remains correct. Only eight patients exhibited a more severe adjustment risk score and had a higher mortality rate (50%). Sixty-six patients were initially categorized in the high-risk class III. Read the rest of this entry »

Simplified Prediction Rule for Prognosis of Patients With Severe Community-Acquired Pneumonia in ICUs: Nonaspiration pneumoniaThe other two predictors, age > 40 years and nonaspiration pneumonia, call for some comments. The impact of age on CAP prognosis appears quite controversial. In some studies, age was an independent predictor of mortality. In others, age affected neither in-hospital mortality nor the outcome during the 24 months after discharge. However, in most of these studies, only the effect of advanced age (> 60, 65, or 75 years) was studied. Fine et al recently presented a prediction rule aimed at identifying low-risk patients with CAP. Age < 50 years was one of the low-risk predictors. Our results could be considered similar because, in our series, the algorithm of Fisher identified 40 years as a cut-off value for prognosis of severe CAP. Read the rest of this entry »

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