Lee Silverman Voice Treatment
Dysphagia can occur at all Parkinsons Disease stages due to some common characteristics including, increased oral transit time, poor bolus formation, oral residue, and/or tongue pumping. Further, aspiration pneumonia becomes a risk because of delayed swallow initiation, piecemeal deglutition or premature spillage of the bolus into the pharynx, gastroesophageal reflux, impaired vocal fold closure, residue in pharynx, and lower esophageal sphincter dysfunction. The Lee Silverman Voice Treatment is a treatment often used with individuals with Parkinsons Disease. It is an intensive program requiring meeting four hours per week plus homework. Although it is primarily for helping with voice, initial research has indicated promising results for swallowing as well. After LSVT, fewer patients presented with reduced tongue coordination and lateralization during oral preparatory phase. Fewer patients also presented with reduced tongue movement, strength in the tongue, or tongue base retraction.
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Overview Of Aspiration Pneumonia
Aspiration is defined as the inhalation of either oropharyngeal or gastric contents into the lower airways, that is, the act of taking foreign material into the lungs. This can cause a number of syndromes determined by the quantity and nature of the aspirated material, the frequency of aspiration, and the host factors that predispose the patient to aspiration and modify the response.
There are four types of aspiration syndromes. Aspiration of gastric acid causes a chemical pneumonitis which has also been called Mendelson syndrome. Aspiration of bacteria from oral and pharyngeal areas causes aspiration pneumonia. Aspiration of oil causes exogenous lipoid pneumonia, an unusual form of pneumonia. Aspiration of a foreign body may cause an acute respiratory emergency and, in some cases, may predispose the patient to bacterial pneumonia. The pathophysiology, clinical presentation, treatment, and complications of each of these entities are different.
This article concentrates on chemical pneumonitis and aspiration pneumonia.
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Arterial Blood Gas And Mixed Venous Gas Analysis
Arterial blood gas analysis is used to assess oxygenation and pH status. ABG analysis adds information that may guide oxygen supplementation. The results of ABG analysis typically demonstrate acute hypoxemia in patients with chemical pneumonitis and normal to low partial pressure of carbon dioxide. A lactate level can be used as an early marker of severe sepsis or septic shock.
A mixed venous gas measurement should be obtained in any patient in whom septic shock is suspected. Decreased mixed venous oxygen saturation can be employed as a marker for septic shock.
Who Is Most Likely To Get Aspiration Pneumonia
Aspiration pneumonia is more common among people who:
- Have had general anesthesia or dental procedures.
- Have trouble coughing or trouble swallowing. Trouble swallowing is known as dysphagia. These issues are more common among people with brain injury or nervous system disorders like Parkinsons disease or multiple sclerosis.
- Have been drinking or taking drugs to excess.
- Are older . Aspiration pneumonia is more common among people who live in nursing homes.
- Have weak immune systems due to some illness, or underdeveloped immune systems due to being very young .
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Pathophysiology Of Aspiration Pneumonia
In aspiration pneumonia, an infiltrate develops in a patient at increased risk of oropharyngeal aspiration. This occurs when a patient inhales material from the oropharynx that is colonized by upper airway flora.
The risk of aspiration is indirectly related to the level of consciousness of the patient . Aspiration of small amounts of material from the buccal cavity, particularly during sleep, is not an uncommon event. No disease ensues in healthy persons, because the aspirated material is cleared by mucociliary action and alveolar macrophages. The nature of the aspirated material, volume of the aspirated material, and state of the host defenses are three important determinants of the extent and severity of aspiration pneumonia.
Coupage Or Chest Percussion Helps Expell Pulmonary And Bronchial Secretions By Stimulating The Cough Reflex
May 13, 2019
With a 25 percent death rate, aspiration pneumonia should be taken seriously. Treatment traditionally includes hospitalization, IV fluids and antibiotics , oxygen therapy, nebulization, and coupage.
Coupage, or chest percussion, helps expell pulmonary and bronchial secretions by stimulating the cough reflex.
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What Causes Aspiration Pneumonia
Pneumonia from aspiration can occur when your defenses are impaired and the aspirated contents have a large amount of harmful bacteria.
You can aspirate and develop pneumonia if your food or drink goes down the wrong way. This may happen even if you can swallow normally and have a regular gag reflex. In that case, most of the time youll be able to prevent this by coughing. Those who have impaired coughing ability, however, may not be able to. This impairment may be due to:
- neurological disorders
How Long Will It Take Me To Recover From Aspiration Pneumonia
Most people recover from aspiration pneumonia in a week or so with treatment. Although you might be ready to return to work or school, you might still be tired for some time after a week. Many people are still tired up to a month into recovery.
Recurrent aspiration due to underlying medical or neurological conditions can be difficult to treat and needs expert care from a multidisciplinary team.
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Epidemiology Of Aspiration Pneumonia
A reliable estimate of incidence of chemical pneumonitis is not available. Few studies have been designed that distinguish between aspiration pneumonia and aspiration pneumonitis. Several studies suggest that 5-15% of the 4.5 million cases of community-acquired pneumonia result from aspiration pneumonia. A retrospective review found that the 30-day mortality rate from aspiration pneumonia is 21% overall and slightly higher in healthcare-associated aspiration pneumonia .
Nosocomial bacterial pneumonia is the second most likely cause of nosocomial infections, second only to urinary tract infection, and it is the leading cause of death from hospital-acquired infections. Approximately 10% of patients who are hospitalized after drug overdoses will have an aspiration pneumonitis.
Nosocomial bacterial pneumonia caused by aspiration is much more frequent in adults than in children, and males are more commonly affected than females. Predisposing factors are more common among elderly people. Thus, this population is more prone to develop aspiration pneumonia. Comparative studies of bacterial pneumonia in patients from the community with those in a continuing care facility have demonstrated a 3-fold increase of this disease in residents of the continuing care facilities .
What Is The Most Likely Cause Of His Aspiration Pneumonia
Pneumonia is an infection in your lungs. One of the ways you can get this infection is by inhaling saliva, food, stomach contents or even foreign objects into your lungs, which is called aspiration pneumonia. This type is more common among certain people, including people with nerve disorders or swallowing issues.
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Presentation Of Aspiration Pneumonia
The clinical presentation of both aspiration pneumonia and pneumonitis ranges from mildly ill and ambulating to critically ill, with signs and symptoms of septic shock and/or respiratory failure.
Host factors and chronic conditions that result in a decreased ability to protect one’s airway include a previous cerebrovascular accident , a history of esophageal diseases including achalasia or esophageal web, being a nursing home patient, and being chronically fed by feeding tube .
Physical examination findings vary depending on the severity of the disease, presence of complications, and host factors. Patients with aspiration pneumonitis secondary to seizure, head trauma, or drug overdose should be inspected for signs related to these processes. In addition to exhibiting signs associated with the underlying disease that led to their aspiration, patients with aspiration pneumonia or pneumonitis may demonstrate the following:
Fever or hypothermia
Aspiration Pneumonia And Chemical Pneumonitis
, MD, University at Buffalo, Jacobs School of Medicine and Biomedical Sciences
Aspiration pneumoniaChemical pneumonitis
Symptoms include cough and shortness of breath.
Doctors make the diagnosis on the basis of the persons symptoms and a chest x-ray.
Treatment and prognosis differ depending on the substance that was aspirated.
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How Can I Take Care Of Myself
Follow the full course of treatment prescribed by your healthcare provider. In addition:
Ask your provider:
Diagnosis In Aspiration Pneumonia
Clinicians must consider the diagnosis of aspiration pneumonia when a patient presents with risk factors and radiographic evidence of an infiltrate suggestive of aspiration pneumonia . The location of the infiltrate on chest radiograph depends on the position of the patient when the aspiration occurred and is discussed further in the Chest Radiography section.
The laboratory studies obtained should be guided by the patientâs clinical presentation . Patients with signs or symptoms of sepsis or septic shock require further laboratory testing than those with uncomplicated aspiration syndromes.
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What Are The Early Symptoms Of Aspiration Pneumonia’
- You may feel generally unwell, with a high temperature , headache, sickness and muscle aches. You might go off your food and lose a little bit of weight.
- A cough is the key feature, sometimes with yellow or green phlegm.
- Your breathing rate and pulse may become rapid.
- Other symptoms you may notice include breathlessness and chest pain which is worse when you breathe in deeply.
- A doctor listening to your chest with a stethoscope might hear that your breathing sounds muffled and that the covering of your lungs makes a sound when you breathe in and out .
- If your chest wall is tapped, the doctor may find an area of dullness.
- Untreated, pneumonia can make you feel very ill. The oxygen you breathe in may have difficulty getting to parts of your body distant from your lungs and may develop a blue tinge.
When Should I See My Healthcare Provider About Aspiration Pneumonia
If you have worrisome symptoms like chest pain, fever and difficulty breathing, call your provider or seek emergency medical help. Pneumonia can get worse more quickly than you realize.
If you often feel like you are choking, or have difficulty swallowing, see your provider. You may need to see a specialist who can help you find out why you are choking or having problems swallowing. You may need to change what and how you eat and drink.
A note from Cleveland Clinic
Pneumonia is an infection in your lungs. One of the ways you can get this infection is by inhaling saliva, food, stomach contents or even foreign objects into your lungs, which is called aspiration pneumonia. This type is more common among certain people, including people with nerve disorders or swallowing issues. Aspiration pneumonia is generally treated with antibiotics. Treatment is successful for most people. Make sure you contact your healthcare provider if you have chest pain, fever and difficulty breathing. As with most conditions, the best outcomes happen when aspiration pneumonia is found early.
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How Is It Treated
Depending on how ill you are, you may need to be in the hospital. Treatment may include:
- Giving you oxygen to breathe
- Having a tube in your throat and a machine to help you breathe and to make sure you are getting enough oxygen
- Giving you IV fluids and medicines, such as antibiotics to treat infection and inhaled medicines to open up the airway
- Thoracentesis, which uses a needle inserted through a space between your ribs to draw out fluid or air. You will feel some immediate relief, but it may take several days for your lung to completely fill with air again.
- If pneumonia causes a continuing buildup of fluid or pus in the space between your lungs and your ribcage, you may need a flexible tube inserted between your ribs into your chest. Suction is often used to help drain infected fluid from the space between your rib cage and lungs. The tube will be removed when the infection is better.
This type of pneumonia often needs several weeks of treatment with an antibiotic. With treatment, you may recover in 1 to 4 weeks. If you are over 60 years old or have other medical problems, it may take longer to get your strength back and feel normal.
How Can Aspiration Pneumonia Be Prevented
If you are bed-bound and at risk of aspiration, keeping the head end of the bed raised at an angle of 30Â° may help.
If you have swallowing difficulties, reduced sensitivity to irritants at the back of your throat, or some other condition that makes you prone to aspiration, feeding through a nasogastric tube may reduce the risk.
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How Is Aspiration Pneumonia Treated
Aspiration pneumonia is treated primarily with antibiotics. The choice of antibiotics depends on several things, including any allergies to penicillin and where the pneumonia was acquired. Hospital-acquired infections must be treated with antibiotics that are effective against many types of bacteria.
Even though aspiration pneumonitis isnt an infection, your provider may start antibiotic therapy, depending on the clinical situation and underlying medical conditions.
Additional treatment might include oxygen therapy or, in life-threatening cases, mechanical ventilation. Mechanical ventilation means that a machine is breathing for you.
Preventing further aspiration is an important part of treatment, since every episode of aspiration can lead to inflammation or infection.
Enhancing Healthcare Team Outcomes
Aspiration pneumonia carries enormous morbidity and mortality. Delays in diagnosis and treatment result in a prolonged hospital stay and additional complications. The management of aspiration pneumonia is with an interprofessional team that consists of a nurse practitioner, primary care provider, internist, infectious disease specialist, radiologist, and pulmonologist.
ICU nurses need to recognize aspiration and take appropriate measures. The head of the bed should be elevated, and if there is suspicion of aspiration, a swallow study should be performed before initiating feedings. The nurse should work with the clinician on educating the patient and family to minimize risks. A dietary consult should be made to determine the optimal method of providing nutrition. Patients need to be observed for respiratory distress. Further, these patients need pressure sore preventive measures and prophylaxis for deep vein thrombosis.
Besides treating pneumonia, it is important to educate the staff looking after the patient on further prevention of aspiration. This means having the head of the bed elevated, close monitoring of oxygen status, and regularly suctioning the oral cavity in patients with swallowing difficulties.
The outlook for patients with aspiration pneumonia depends on the severity of the infection, comorbidity, age, presence of ARDS, and response to antibiotics. If there is a delay in treatment, the mortality rates are high.
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Respiratory Trainers: Imst And Emst
Respiratory muscle strength measures inspiratory and expiratory pressure. If a patient is breathless, demonstrates a weak cough, or has a known neuromuscular or neurodegenerative disease respiratory pressure generating tool may be helpful. There are two classes, inspiratory muscle strength trainers and expiratory muscle strength trainers . IMST devices are typically used for persons with COPD, ALS, Myasthenia Gravis, Cystic Fibrosis, Asthma, Spinal Cord Injury, Diaphragmatic Paralysis, and some athletes . There are several IMST devices: Isocapnic Hyperpnea Trainers, Incentive Spirometers, Resistive Trainers, Pressure Threshold Trainers, Computer-controlled biofeedback, and The Breather. For EMST, there are only two devices, The Breather and ESMT150. Both devices can be used for Dysphagia, Stroke, Parkinsons Disease, COPD, and Spinal cord injury. However, The Breather is better suited for Congestive Heart Failure, Asthma, Vocal Fold Pathologies, Ventilator/Trach Weaning, Sleep Apnea, and Hypertension and ESMT150 can be used with Pompes Disease, ALS, Athletes, Vocalists & musicians, and Navy divers & military personnel.
How To Prevent Aspiration
About Aspiration. Aspiration is when food or liquid goes into your airway instead of your esophagus.
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What Increases My Risk For Aspiration Pneumonia
Your risk is highest if you are older than 75 or live in a nursing home or long-term care center. You may become less active as you age, or you may be bedridden. You may not be able to swallow or cough well. The following also increase your risk for aspiration pneumonia:
- The muscles that help you swallow are weakened by stroke, Alzheimer disease, or other diseases
- A weakened immune system caused by diabetes, COPD, heart failure, or other health problems
- Smoking cigarettes
- Use of a feeding tube or ventilator that allows bacteria to travel to your lungs
- Surgery or radiation to treat cancer of the head or neck
- Poor oral hygiene, teeth that are missing, or dentures
- Alcoholism or IV drug use