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{{Aspiration pneumonia}}
{{Aspiration pneumonia}}
{{CMG}}; {{AE}}  
{{CMG}}; {{AE}} {{SSH}}


==Overview==
==Overview==
There are no established measures for the primary prevention of [disease name].
Effective measures for the primary prevention of aspiration pneumonia include [[Diet (nutrition)|dietary]] habit changes, maintaining [[oral hygiene]], postural maneuvers, and [[Medication|medications]] such as [[H2 antagonist|H2 antagonists]], [[metoclopramide]], [[mosapride]], [[amantadine]], or [[cilostazol]].
 
OR
 
There are no available vaccines against [disease name].
 
OR
 
Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].
 
OR
 
[Vaccine name] vaccine is recommended for [patient population] to prevent [disease name]. Other primary prevention strategies include [strategy 1], [strategy 2], and [strategy 3].


==Primary Prevention==
==Primary Prevention==
 A number of interventions (eg, positioning, dietary changes, drugs, oral hygiene, tube feeding) have been proposed to prevent aspiration, especially in older adult patients and stroke patients:
*Effective measures for the primary prevention of aspiration pneumonia include:<ref name="pmid18179994">{{cite journal |vauthors=El Solh AA, Saliba R |title=Pharmacologic prevention of aspiration pneumonia: a systematic review |journal=Am J Geriatr Pharmacother |volume=5 |issue=4 |pages=352–62 |date=December 2007 |pmid=18179994 |doi=10.1016/j.amjopharm.2007.12.005 |url=}}</ref><ref name="pmid18261707">{{cite journal |vauthors=Sarin J, Balasubramaniam R, Corcoran AM, Laudenbach JM, Stoopler ET |title=Reducing the risk of aspiration pneumonia among elderly patients in long-term care facilities through oral health interventions |journal=J Am Med Dir Assoc |volume=9 |issue=2 |pages=128–35 |date=February 2008 |pmid=18261707 |doi=10.1016/j.jamda.2007.10.003 |url=}}</ref><ref name="pmid23238778">{{cite journal |vauthors=Takatori K, Yoshida R, Horai A, Satake S, Ose T, Kitajima N, Yoneda S, Adachi K, Amano Y, Kinoshita Y |title=Therapeutic effects of mosapride citrate and lansoprazole for prevention of aspiration pneumonia in patients receiving gastrostomy feeding |journal=J. Gastroenterol. |volume=48 |issue=10 |pages=1105–10 |date=October 2013 |pmid=23238778 |doi=10.1007/s00535-012-0725-6 |url=}}</ref>
 
**Bed positioning
●Percutaneous endoscopic gastrostomy tubes and nasogastric tubes are more efficient for delivering nutrition and oral medications in patients with dysphagia but have not been shown to reduce the incidence of aspiration pneumonia [14-16].
**[[Diet (nutrition)|Dietary]] habit changes such as:
 
***Eating small meals at a slow pace and consistent
●In a small study of mechanically ventilated patients, aspiration into the bronchi was less likely in patients in the semi-recumbent (45 degree) position compared with those who were supine [17]. Nevertheless, a subsequent systematic review of randomized controlled trials of such measures found insufficient data to assess effectiveness [18].
***Elevated position at least 1 to 2 hours after meals
 
***Elemental diets in bedridden [[PEG gastroscopy|PEG]] patients
●A subsequent randomized trial compared chin-down position and oral feedings of two consistencies (nectar thickened or honey thickened) on the incidence of aspiration as assessed by videofluorography in 711 patients with dementia or Parkinson disease [19]. Significantly more patients aspirated on thin liquids using the chin-down posture (68 percent) than when using nectar-thickened liquids (63 percent) or honey-thickened liquids (53 percent). However, a separate report evaluating the incidence of pneumonia at three months in a subset of 515 patients found no significant difference between the two groups (9.8 versus 11.6 percent) [20]. There was no control group, so one cannot determine if the interventions were effective.
**Good [[oral hygiene]] such as:
 
***Professional cleaning of the oral cavity weekly
●
***Tooth brushing after each meal
 
***Cleaning [[dentures]] daily
A randomized trial sought to determine whether a multicomponent strategy (including manual tooth/gum brushing plus 0.12% chlorhexidine oral rinse twice daily plus upright positioning during feeding) could reduce the incidence of pneumonia in nursing home residents compared with usual care, but the trial was terminated for futility [21]. It might have been difficult to detect a difference between the groups since upright positioning during feeding is practiced routinely in nursing homes [22], and oral hygiene is also a common part of usual nursing home care.
***Gargling of [[disinfectant]] solution
 
**Postural maneuvers and [[swallowing]] training to improve [[swallowing]] difficulties
 
**Checking [[Feeding tube|feeding tubes]] regularly to prevent displacement
 
**Administrating postpyloric [[feeding]] than [[Feeding tube|gastric feeding]]
**[[Medication|Medications]] such as:
***[[H2 antagonist|Histamine-2 receptor antagonists]]
***[[Metoclopramide]] 
***[[Mosapride]] 
***[[Amantadine]] 
***[[Cilostazol]] 
==References==
==References==
{{Reflist|2}}
{{Reflist|2}}

Latest revision as of 16:39, 4 April 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sadaf Sharfaei M.D.[2]

Overview

Effective measures for the primary prevention of aspiration pneumonia include dietary habit changes, maintaining oral hygiene, postural maneuvers, and medications such as H2 antagonists, metoclopramide, mosapride, amantadine, or cilostazol.

Primary Prevention

References

  1. ↑ El Solh AA, Saliba R (December 2007). "Pharmacologic prevention of aspiration pneumonia: a systematic review". Am J Geriatr Pharmacother. 5 (4): 352–62. doi:10.1016/j.amjopharm.2007.12.005. PMID 18179994.
  2. ↑ Sarin J, Balasubramaniam R, Corcoran AM, Laudenbach JM, Stoopler ET (February 2008). "Reducing the risk of aspiration pneumonia among elderly patients in long-term care facilities through oral health interventions". J Am Med Dir Assoc. 9 (2): 128–35. doi:10.1016/j.jamda.2007.10.003. PMID 18261707.
  3. ↑ Takatori K, Yoshida R, Horai A, Satake S, Ose T, Kitajima N, Yoneda S, Adachi K, Amano Y, Kinoshita Y (October 2013). "Therapeutic effects of mosapride citrate and lansoprazole for prevention of aspiration pneumonia in patients receiving gastrostomy feeding". J. Gastroenterol. 48 (10): 1105–10. doi:10.1007/s00535-012-0725-6. PMID 23238778.

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