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BACKGROUND: Oropharyngeal dysphagia (OD) is common among older adults. Some studies have evaluated the efficacy of a texture-modified diet on mortality but with short-term follow-up. We aimed to evaluate the effect of a texture-modified diet and controlled bolus volume on all-cause mortality after 12 months in older persons with OD. METHODS: This secondary analysis of a randomized clinical trial included patients aged ≥60 years with a diagnosis of OD. They were concurrently and randomly assigned to receive either a texture-modified food diet and controlled bolus volume (intervention group) or standard treatment (control group) with 12 months of follow-up. Secondary outcomes were oral intake, weight, handgrip strength, phase angle, and aspiration pneumonia. Kaplan-Meier analysis and the Cox proportional hazards model were used for mortality analysis. RESULTS: A total of 127 participants (intervention group: 64 and control group: 63) were recruited, with a mean age of 76 years. The probability of all-cause mortality was significantly lower in the intervention group (n = 8, 12%) than in the control group (n = 18, 29%) (hazard ratio = 0.36 [95% CI = 0.16-0.86]; P = 0.01). There were 5 (7.9%) and 10 (16.1%) aspiration pneumonia events in the intervention and control groups, respectively (not significant) in 12 months of follow-up. Changes were observed in protein consumption (P = 0.01), body weight (P = 0.04), body mass index (P = 0.004), handgrip strength (P = 0.02), and phase angle (P = 0.04) between the treatment groups. CONCLUSION: Compared with the standard treatment, the dietary intervention improved efficacy by limiting nutrition complications, aspiration pneumonia, and all-cause mortality.

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The association between impairments in swallowing safety detected via fiberoptic endoscopic evaluation of swallowing (FEES) and dysphagia complications has been evaluated in small studies that have not allowed obtaining precise estimates of the presence of such an association. The objective of this study was to evaluate the risk of dysphagia complications associated with the detection of premature spillage, residue, penetration, and aspiration via FEES. A systematic review and meta-analysis of the literature were carried out. A search strategy was established using terms of controlled and free vocabulary (free text) in the PubMed, Lilacs, Embase, Medline, and Cochrane databases. The initial search in the databases identified 3545 articles, of which 321 were excluded due to duplication, 3224 were selected for review of titles and abstracts, 45 were selected for full-text review, 37 were excluded for not meeting the selection criteria, and 8 were included for the final analysis, with a total population of 1168 patients. Aspiration increased the risk of pneumonia (OR 2.97, 95% CI 1.52-5.80, P = 0.001). The number of studies that have evaluated the relationship of other FEES findings with dysphagia complications was limited (≤ 3). One study found a higher risk of mortality in patients with aspiration (OR 4.08, 95% CI 1.60-10.27, P = 0.003). Another study that evaluated the risk of mortality in a combined group of penetration and aspiration found no higher risk of mortality. Penetration, residue, and premature spillage were not found to be associated with an increased risk of pneumonia, mortality, or other outcomes. Aspiration demonstrated via FEES was associated with an increased risk of pneumonia and mortality. There is insufficient evidence for the capacity of premature spillage, penetration, and residue to predict dysphagia complications.

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Background: Laryngeal paralysis is a disorder that affects the movement of the arytenoid cartilages, creating an obstacle to the passage of air during inspiration. The disease is progressive and clinical signs are associated with upper airway obstruction. Diagnosis occurs through observation of laryngeal movements, and it is important to rule out concomitant diseases. In severely affected animals, surgery is recommended to alleviate clinical signs and improve quality of life. The aim of this report is to report a case of idiopathic laryngeal paralysis in a dog submitted to arytenoid unilateralization to clear the upper airways and evaluate the effectiveness of the technique. Case: A 5-year-old male Great Dane dog was referred to the Hospital de Clínicas Veterinárias (HCV) of the Federal University of Rio Grande do Sul (UFRGS) with severe respiratory distress and respiratory stridor. The animal was taken directly to the emergency room, where it was promptly submitted to oxygen therapy with the aid of a mask, was medicated with nalbuphine hydrochloride 0.3 mg/kg intramuscularly and venous access was performed. After stabilization, complete blood count, biochemical profile, blood gas analysis and chest X-ray were requested. In the anamnesis, the tutor reported that the dog showed signs of fatigue with exercise intolerance, coughing similar to choking, breathing difficulties and noisy breathing, especially on hotter days and in situations of exertion, stress or euphoria. He mentioned that the signs were progressive, having started 2 months ago and that they were more frequent and lasting. The patient was diagnosed with laryngeal paralysis through transoral laryngoscopy and referred to surgery. The improvement in the breathing pattern and the absence of post-surgical complications resulted in the patient being discharged 6 days after hospitalization. Discussion: When the origin of laryngeal paralysis (LP) is undefined, the acquired form may be a consequence of generalized polyneuropathy, polymyopathy, neoplasia, endocrinopathy, iatrogenic or idiopathic injury. The patient under study did not present clinical signs or history of disease, therefore, the case was classified as idiopathic in origin. Laryngeal paralysis of unknown cause is the most common and affects mainly middle-aged to elderly males, large or giant breeds. The disease is often described in Labrador Retriever dogs, but it can affect other breeds such as Great Dane. This information corroborates the profile of the patient in this study. Although oral laryngoscopy is the recommended method for confirming the diagnosis in dogs with characteristic signs of LP, the diagnosis can also be obtained by transnasal laryngoscopy or echolaryngography, however, previous studies have shown that the sensitivity and specificity of diagnosis through echoaryngography is inferior to transnasal laryngoscopy, suggesting that direct visualization of the larynx is better to indirect visualization. Dogs with signs of moderate to severe respiratory distress or whose quality of life is affected as a result of LP are candidates for surgical treatment, as in this case, in which the patient had exercise intolerance and severe respiratory distress. The arytenoid unilateralization procedure proved to be effective in improving the quality of life of the patient under study, achieving excellent postoperative results and approval by the tutor. In this case, transoral laryngoscopy was essential to determine the diagnosis and establish the treatment. Although the goal of improving quality of life has been achieved without major complications, the animal must receive long-term follow-up due to a possible correlation with generalized polyneuropathy and long-term complications.

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Early detection of dysphagia and specifically aspiration is essential to prevent and reduce complications of hospitalized patients in rehabilitation centers. Bedside screening test are often used to evaluate swallowing disorders, but their results may be questionable due to insufficient and inconsistent sensitivity and specificity. To compare the sensitivity and specificity of various bedside screening tests for detecting aspiration in hospitalized rehabilitation patients. A prospective observational study was performed in 150 consecutive patients of a tertiary rehabilitation hospital. Patients were evaluated regarding clinical predictors for aspiration, maximum phonation time (MPT), Eating Assessment Tool 10 (EAT-10) questionnaire, tongue strength and endurance (Iowa Oral Performance Instrument [IOPI]) and a swallowing test (Volume-Viscosity Swallow Test [V-VST]). Flexible Endoscopic Evaluation of Swallowing (FEES) was the reference test. Of the 144 patients included, 22% aspirated on FEES. Previous history of pneumonia, dysarthria, wet voice, and abnormal cough reflex were significantly associated with aspiration. The sensitivity, specificity and accuracy for V-VST (83.3%, 72.6%, 74.8%, respectively) and EAT-10 (82.8%, 57.7%, 62.8%, respectively) to detect aspiration were superior than those of other methods. Maximum tongue strength on IOPI and MPT presented high sensitivity but low specificity to detect aspiration. Clinical predictors of aspiration (previous history of pneumonia, dysarthria, wet voice, and abnormal cough reflex) associated with either V-VST or EAT-10 may be good screening methods to detect aspiration in patients hospitalized in a rehabilitation center.

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La neumonía lipoidea es una enfermedad respiratoria poco conocida que resulta de la acumulación de lípidos de origen endógeno o exógeno a nivel del alveolo pulmonar. Suele ser subdiagnosticada ya que la presentación clínica es inespecífica, por lo que suele confundirse con otras patologías broncopulmonares. Se presentó el caso de un paciente de 18 años antecedentes de aspiración accidental de combustible que seis horas después comenzó con fiebre, hemoptisis, tos y disnea. Se realizó radiografía de tórax donde se observó una neumonía en base derecha que unido al interrogatorio y a la realización de la broncoscopía confirmaron el diagnóstico de neumonía lipoidea. El paciente evolucionó favorablemente con el tratamiento(AU)

Lipoid pneumonia is a little known respiratory disease that results from the accumulation of lipids of endogenous or exogenous origin in the pulmonary alveolus. It is usually underdiagnosed since the clinical presentation is nonspecific, which is why it is often confused with other bronchopulmonary pathologies. We report the case of an 18-year-old patient with a history of accidental fuel aspiration, who ran fever six hours later, together with hemoptysis, cough, and dyspnea. Chest X-rays showed a right base pneumonia. The questioning and the performance of the bronchoscopy confirmed the diagnosis of lipoid pneumonia. The patient evolved favorably with the treatment(AU)

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RESUMEN: ¿Por qué es importante la salud oral en la prevención de enfermedades respiratorias en tiempos de pandemia? La razón es simple, cualquier enfermedad respiratoria en la persona mayor, podría eventualmente activar alarma de COVID-19 positivo, pudiendo ser esta ocasionada por otro motivo, sin mencionar el riesgo aumentado de tener una enfermedad previa de tipo respiratoria en tiempos de pandemia, sobre todo, en una población de riesgo como las personas mayores institucionalizadas. Por esta razón, la prevención en higiene oral de personas mayores mediante un Protocolo que proponga lineamientos a seguir en Establecimientos de Larga Estadía para Adultos Mayores, es fundamental en la prevención de Neumonía por aspiración. Cabe mencionar, que desde antes de surgir el COVID-19, ya la Neumonía se considera la principal causa de muerte por enfermedades infecciosas en la población chilena, y la primera causa específica de muerte en los mayores de 80 años.

ABSTRACT: Why is oral health important in the prevention of respiratory diseases in times of pandemic? The reason is simple, any respiratory disease in the elderly could eventually trigger a positive COVID-19 alarm, and this could be caused by another reason, not to mention the increased risk of having a previous respiratory-type illness in times of pandemic, over everything, in a population of risk like the institutionalized older people. For this reason, the prevention of oral hygiene in older people through a Protocol that proposes guidelines to be followed in long-stay establishments for older adults, is essential in the prevention of aspiration Pneumonia. It is worth mentioning that, before the emergence of COVID-19, Pneumonia was considered the main cause of death from infectious diseases in the Chilean population and the first specific cause of death in those over 80 years of age.

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RESUMEN Introducción: La disfagia tiene una morbimortalidad importante en pacientes hospitalizados. Objetivos: principal; describir las características de los pacientes con disfagia hospitalizados y, secundarios; cuantificar y analizar la prevalencia de mortalidad y de reingresos. Metodología: Estudio transversal descriptivo de las hospitalizaciones por disfagia durante el año 2015 en un Hospital General Universitario. Resultados: Se evaluaron 431 historias clínicas. La edad de los pacientes fue de 83,21 (DE 11,4) años, el 52,5% fueron mujeres y el 47,2% varones; la estancia media fue de 11,1 (DE 7,99) días. En el 71,2 % de los casos la disfagia fue por afectación de la fase orofaríngea. En el 80,51% de los casos se diagnosticaron complicaciones respiratorias: 48,12% neumonía aspirativa por líquidos, 40,05 % neumonitis química por aspiración y 11,81% neumonía aspirativa por sólidos. La mortalidad general asociada a las complicaciones respiratorias respecto del total de los casos de disfagia fue del 24,49%. El 50,48% de los pacientes con neumonía aspirativa fallecieron. La principal causa de la disfagia fue las enfermedades neurológicas (un 77,25%). La mortalidad fue significativamente mayor en las mujeres - 42,3% frente al 7,8% - (p < 0,01) y esta diferencia se mantuvo tras ajustar el resultado por edad: OR 9,937, IC95%: 5,446; 18,131. El 13,10% de los pacientes reingresaron al menos en una ocasión. Los pacientes de geriatría presentaron un mayor número de reingresos por número de ingresos. Discusión: las enfermedades neurológicas fueron la principal causa de disfagia. La mortalidad fue significativamente mayor en las mujeres.

ABSTRACT Introduction: Dysphagia is an important associated morbidity and mortality in hospitalized patient. Objectives: Main; to describe the characteristics of patients admitted for dysphagia and secondary; quantify and analyze the prevalence of mortality and readmissions. Methodology: Cross-sectional study descriptive revenues by dysphagia during the year 2015 in a University General Hospital. Results: 431 records were evaluated. The age of the patients was 83,21 (11.4), 52.5% women and 47.2% male; the average stay was 11.1 (7.99) days. In 71,2% of cases the dysphagia was involvement of the oropharyngeal phase. 80.51% of cases were diagnosed respiratory complications. The percentage distribution of these complications were: in 48.12% aspiration pneumonia due to fluids, in 40.05% chemical aspiration pneumonitis and in 11.81% aspiration pneumonia due to solids. The overall mortality associated with respiratory complications compared to the total of cases of dysphagia was 24.49%. 50.48% of patients diagnosed with aspiration pneumonia died. The main cause of dysphagia was neurological diseases (77.25%). Mortality was significantly higher in women - 42.3% of women compared with 7.8% of males - (p < 0.01) and this difference remained after adjusting the result by age: OR 9,937, 95% CI: 5,446; 18,131. 13.10% of patients re-entered at least on one occasion. Patients of geriatric unit that presented in greater number of readmissions by admissions. Discussion: neurological diseases were the main cause of dysphagia. Mortality was significantly higher in women

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ABSTRACT Purpose: to identify associated factors and preventive measures for aspiration pneumonia in hospitalized elderly patients. Methods: the PPOT (population, predictor, outcome, and type of study) was the strategy used to define the eligibility criteria: (1) Population: people over 60 years of age; (2) predictor: hospitalized patients (3) Outcomes: associated factors and measures to prevent aspiration pneumonia; (4) Type of study: Observational Studies (transversal and case-control). We performed the data collection in the PubMed, Lilacs, Scielo, Google Scholar, Science Direct, and Web of Science databases. Observational studies on factors associated with aspiration pneumonia and preventive measures in the elderly, without language restriction and available in full, were included. Data on authors/year/country, objective, methodology, sample, and results, were collected. The risk of bias was assessed, according to the JBI Critical Appraisal Checklist. Results: a case-control and two cross-sectional studies were analyzed. One paper presented a smaller sample with 86 patients, and another presented a larger sample comprising 443 patients. The median age was 77 years old. Conclusion: factors such as severe stroke, dysphagia, advanced age, male gender, coronary heart disease, lower Glasgow coma scale score, use of mechanical ventilation for more than 48 hours, and aspiration of colonized gastric juice were associated with aspiration pneumonia.

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Introdução: Penetração e/ou aspiração laringotraqueal (PA) são achados clínicos que constituem importante parâmetro na mensuração do risco para a segurança da deglutição devido às possíveis complicações pulmonares. Objetivo: Identificar a prevalência de penetração e/ou aspiração na Doença de Parkinson (DP) em Centro Especializado de Reabilitação (CER). Método: Estudo clínico observacional retrospectivo. Foram analisados 39 laudos de exames de videoendoscopia da deglutição realizadas em Centro Especializado de Reabilitação "Universidade Estadual Paulista-UNESP/Marília", no período de 2006 a 2016. Dos 39 (100%) indivíduos, 19 (48,71%) eram do gênero feminino e 20 (51,28%) do gênero masculino, com idade que variou de 43 a 85 anos (média de idade de 71 anos) e somente 29 (74,35%) desses indivíduos apresentavam classificação de Hoehn & Yahr (1967) variando de um a cinco. Realizada análise da PA nas consistências pastosa, líquida espessada e líquida e com volume que variou de 5 a 10 ml segundo a definição proposta por Rosenbek et al, 1996. Para análise estatística foi utilizado o Teste de Fisher. Resultados: Constatou-se que 28 (71,79%) indivíduos não apresentaram penetração e/ou aspiração laringotraqueal e 11 (28,21%) apresentaram. Desses 11 (28,21%), quatro (10,25%) apresentaram penetração/aspiração na consistência pastosa (p=0,05), nove (23,07%) no líquido espessado (p=0,07) e nove (23,07%) no líquido ralo (p=0,02). Conclusão: Na população estudada nesse setting a ausência de PA foi mais frequente e a presença significante apenas no líquido ralo.

Introduction: Laryngotracheal penetration and/or aspiration are clinical findings that are an important parameter in the measurement of the risk for swallowing safety due to possible pulmonary complications. Objective: To identify the prevalence of penetration and/or aspiration in Parkinson's disease (PD) in a Specialized Rehabilitation Center. Method: Retrospective observational clinical study. We analyzed 39 reports of fiberoptic endoscopy swallowing test performed at the Dysphagia Rehabilitation Center "University of São Paulo-UNESP/Marília" from 2006 to 2016. Of the 39 (100%) individuals, 19 (48.71%) were female and 20 (51.28%), ranging from 43 to 85 years old (mean age of 71 years), and only 29 (74.35%) of these individuals presented a classification of Hoehn & Yahr (1967) ranging from one to five. The analysis of the penetration and aspiration was performed in paste, liquid, thickened and liquid consistencies, with a volume varying from 5 to 10 ml according to the definition proposed by Rosenbek et al., 1996. For the statistical analysis Fisher's test was used. Results: It was verified that 28 (71.79%) individuals presented no laryngotracheal penetration and/or aspiration and 11 (28.21%) presented. Of these 11 (28.21%), four (10.25%) presented penetration / aspiration in paste consistency (p = 0.05), nine (23.07%) in the thickened liquid (p = 0.07) and nine (23.07%) in the thin liquid (p = 0.02). Conclusion: In the population studied in this setting, the absence of penetration and/or aspiration was more frequent and the presence was significant only of the liquid.

Introducción: Penetración y/o aspiración laringotraqueal (PA) son hallazgos clínicos que constituyen un importante parámetro en la medición del riesgo para la seguridad de la deglución debido a las posibles complicaciones pulmonares. Objetivo: Identificar la prevalencia de penetración y / o aspiración en la Enfermedad de Parkinson (DP) en Centro Especializado de Rehabilitación (CER). Método: Estudio clínico observacional retrospectivo. Se analizaron 39 casos de exámenes de videoendoscopia de la deglución realizados en Centro Especializado de Rehabilitación "Universidade Estadual Paulista-UNESP/Marília", del período de 2006 a 2016. De los 39 (100%) individuos, 19 (48,71%) eran del género femenino y 20 (51,28%) del género masculino, con edad que varía de 43 a 85 años (mediana de edad de 71 años) y solamente 29 (74,35%) de estos individuos presentaban clasificación de Hoehn & Yahr (1967) variando de uno a cinco años. Se realizó un análisis de la PA en las consistencias pastosa, líquida espesa y líquida y con volumen que varía de 5 a 10 ml según la definición propuesta por Rosenbek et al, 1996. Para el análisis estadístico se utilizó el test de Fisher. Resultados: Se constató que 28 (71,79%) individuos no presentaron penetración y / o aspiración laringotraqueal y 11 (28,21%) presentaron. En la mayoría de los casos, se observó una disminución de la producción de leche en la leche materna, (23,07%) en el líquido ralo (p = 0,02). Conclusión: En la población estudiada en ese ajuste la ausencia de PA fue más frecuente y la presencia significante sólo en el líquido.

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Abstract Background and objectives: Pregnant women are considered patients at risk for pulmonary aspiration of gastric contents. The study aim was to evaluate the gastric antral cross-sectional area using ultrasound. Method: In this prospective study, 85 scheduled term pregnant women underwent gastric ultrasound. The outcomes were the measurement of the gastric antral cross-sectional area (main outcome), the estimated gastric volume, the incidence of pregnant women at risk for pulmonary aspiration, and the association between gastric antral cross-sectional area and clinical-demographic characteristics. Gastric antral cross-sectional area and gastric volume were compared according to body mass index <30 or ≥30. Results: The median (IIQ) for gastric antral cross-sectional area was 4 cm2 (2.8-6.3), for the estimated gastric volume it was 49.8 mL (33.7-87.2), and for the gastric volume estimated in mL.kg-1 it was 0.62 mL.kg-1 (0.39-0.95). The 95th percentile [95% confidence interval (CI)] of the gastric antral cross-sectional area and the estimated gastric volume were ≤10.3 cm2 (95% CI: 7.6-15.6) and 1.42 mL.kg-1 (95% CI: 1.20-2.64), respectively. The incidence of pregnant women at risk for pulmonary aspiration was 3.5% (CI: 3.5 (1.2-9.8)). There was a positive correlation between gastric antral cross-sectional area and weight, p < 0.001 and body mass index <0.001. Patients with a body mass index ≥30 had a gastric antral cross-sectional area and an estimated gastric volume greater than those with a body mass index <30, respectively, p < 0.01 and p < 0.02. Conclusion: Measuring the gastric antral cross-sectional area of pregnant women is feasible and easy. There was positive correlation between gastric antral cross-sectional area, body weight and body mass index. The estimation of gastric volume by measuring the gastric antral cross-sectional area can identify patients at risk for pulmonary aspiration. Obese patients had a gastric antral cross-sectional area and an estimated gastric volume greater than non-obese patients.

Resumo Justificativa e objetivos: As gestantes são consideradas pacientes de risco para aspiração pulmonar do conteúdo gástrico. O objetivo foi avaliar a área transversal do antro gástrico por meio de ultrassonografia. Método: Neste estudo prospectivo, 85 gestantes a termo agendadas foram submetidas à ultrassonografia do antro gástrico. Os desfechos foram a mensuração da área transversal do antro gástrico (desfecho principal), a estimativa do volume gástrico, a incidência de gestantes sob risco de aspiração pulmonar, a associação entre a área transversal do antro gástrico e características clínico-demográficas. A área transversal do antro gástrico e do volume gástrico foi comparada de acordo com o índice de massa corporal < 30 ou ≥ 30. Resultados: A mediana (IIQ) da área transversal do antro gástrico foi 4 cm2 (2,8-6,3), do volume gástrico estimado 49,8 mL (33,7-87,2) e do volume gástrico estimado em mL.kg-1 de 0,62 mL.kg-1 (0,39-0,95). O percentil 95 [intervalo de confiança (IC) 95%] da área transversal do antro gástrico e do volume gástrico estimado foi ≤ 10,3 cm2 (IC 95%: 7,6-15,6) e 1,42 mL.kg-1 (IC 95%: 1,20-2,64), respectivamente. A incidência de gestantes sob risco de aspiração pulmonar foi de 3,5% (IC: 3,5 (1,2-9,8). Houve correlação positiva entre a área transversal do antro gástrico e peso, p < 0,001 e índice de massa corporal p < 0,001. As pacientes com índice de massa corporal ≥ 30 apresentaram maior área transversal do antro gástrico, e do volume gástrico estimado, do que as com índice de massa corporal < 30, respectivamente p < 0,01 e p < 0,02. Conclusão: A mensuração da área transversal do antro gástrico de gestantes é factível e fácil. A área transversal do antro gástrico correlacionou-se positivamente com peso e índice de massa corporal. A estimativa do volume gástrico através da mensuração da área transversal do antro gástrico pode identificar pacientes sob risco de aspiração pulmonar. As pacientes obesas apresentaram área transversal do antro gástrico e volume gástrico estimado maior do que as não obesas.

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