The Experts below are selected from a list of 291 Experts worldwide ranked by ideXlab platform
Baruch Krauss - One of the best experts on this subject based on the ideXlab platform.
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Pulmonary Aspiration during procedural sedation a comprehensive systematic review
BJA: British Journal of Anaesthesia, 2017Co-Authors: Steven M Green, Keira P Mason, Baruch KraussAbstract:Abstract Background Although Pulmonary Aspiration complicating operative general anaesthesia has been extensively studied, little is known regarding Aspiration during procedural sedation. Methods We performed a comprehensive, systematic review to identify and catalogue published instances of Aspiration involving procedural sedation in patients of all ages. We sought to report descriptively the circumstances, nature, and outcomes of these events. Results Of 1249 records identified by our search, we found 35 articles describing one or more occurrences of Pulmonary Aspiration during procedural sedation. Of the 292 occurrences during gastrointestinal endoscopy, there were eight deaths. Of the 34 unique occurrences for procedures other than endoscopy, there was a single death in a moribund patient, full recovery in 31, and unknown recovery status in two. We found no occurrences of Aspiration in non-fasted patients receiving procedures other than endoscopy. Conclusions This first systematic review of Pulmonary Aspiration during procedural sedation identified few occurrences outside of gastrointestinal endoscopy, with full recovery typical. Although diligent caution remains warranted, our data indicate that Aspiration during procedural sedation appears rare, idiosyncratic, and typically benign.
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Pulmonary Aspiration risk during emergency department procedural sedation an examination of the role of fasting and sedation depth
Academic Emergency Medicine, 2002Co-Authors: Steven M Green, Baruch KraussAbstract:The assessment of pre-procedure fasting and control of sedation depth are prominent elements of widely disseminated procedural sedation guidelines and of the Joint Commission on Accreditation of Healthcare Organizations' standards. Both exist primarily to minimize the risk of Pulmonary Aspiration of gastric contents. This paper critically examines the literature on pre-procedure fasting and controlling sedation depth in association with Pulmonary Aspiration, and interprets this evidence in the context of modern emergency medicine practice. The article reviews the pathophysiology of Aspiration and changing concepts regarding Aspiration risk over the last decade. After reviewing studies on Aspiration risk during general anesthesia, the paper reviews the risk of Aspiration during labor and delivery as a more appropriate comparison group for Aspiration risk during emergency department procedural sedation and analgesia (ED PSA). It is noted that Aspiration during ED PSA has not been reported in the medical literature and that Aspiration during general anesthesia and labor and delivery is uncommon. The literature provides no compelling evidence to support specific fasting periods for either liquids or solids prior to PSA, and existing guidelines for elective patients are of necessity arbitrary and based upon consensus opinion. The article discusses the implications in the areas of training and preparedness, monitoring, and research for the emergency physician practicing PSA.
Steven M Green - One of the best experts on this subject based on the ideXlab platform.
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Pulmonary Aspiration during procedural sedation a comprehensive systematic review
BJA: British Journal of Anaesthesia, 2017Co-Authors: Steven M Green, Keira P Mason, Baruch KraussAbstract:Abstract Background Although Pulmonary Aspiration complicating operative general anaesthesia has been extensively studied, little is known regarding Aspiration during procedural sedation. Methods We performed a comprehensive, systematic review to identify and catalogue published instances of Aspiration involving procedural sedation in patients of all ages. We sought to report descriptively the circumstances, nature, and outcomes of these events. Results Of 1249 records identified by our search, we found 35 articles describing one or more occurrences of Pulmonary Aspiration during procedural sedation. Of the 292 occurrences during gastrointestinal endoscopy, there were eight deaths. Of the 34 unique occurrences for procedures other than endoscopy, there was a single death in a moribund patient, full recovery in 31, and unknown recovery status in two. We found no occurrences of Aspiration in non-fasted patients receiving procedures other than endoscopy. Conclusions This first systematic review of Pulmonary Aspiration during procedural sedation identified few occurrences outside of gastrointestinal endoscopy, with full recovery typical. Although diligent caution remains warranted, our data indicate that Aspiration during procedural sedation appears rare, idiosyncratic, and typically benign.
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Pulmonary Aspiration risk during emergency department procedural sedation an examination of the role of fasting and sedation depth
Academic Emergency Medicine, 2002Co-Authors: Steven M Green, Baruch KraussAbstract:The assessment of pre-procedure fasting and control of sedation depth are prominent elements of widely disseminated procedural sedation guidelines and of the Joint Commission on Accreditation of Healthcare Organizations' standards. Both exist primarily to minimize the risk of Pulmonary Aspiration of gastric contents. This paper critically examines the literature on pre-procedure fasting and controlling sedation depth in association with Pulmonary Aspiration, and interprets this evidence in the context of modern emergency medicine practice. The article reviews the pathophysiology of Aspiration and changing concepts regarding Aspiration risk over the last decade. After reviewing studies on Aspiration risk during general anesthesia, the paper reviews the risk of Aspiration during labor and delivery as a more appropriate comparison group for Aspiration risk during emergency department procedural sedation and analgesia (ED PSA). It is noted that Aspiration during ED PSA has not been reported in the medical literature and that Aspiration during general anesthesia and labor and delivery is uncommon. The literature provides no compelling evidence to support specific fasting periods for either liquids or solids prior to PSA, and existing guidelines for elective patients are of necessity arbitrary and based upon consensus opinion. The article discusses the implications in the areas of training and preparedness, monitoring, and research for the emergency physician practicing PSA.
Hongming Zhuang - One of the best experts on this subject based on the ideXlab platform.
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Value of salivagram in the diagnosis of Pulmonary Aspiration in pediatric patients
Chinese Journal of Nuclear Medicine and Molecular Imaging, 2016Co-Authors: Jigang Yang, Hongming ZhuangAbstract:Objective To investigate the value of salivagram in the diagnosis of pediatric Pulmonary Aspiration. Methods A total of 469 pediatric patients (age: 6 weeks-16 years, average age (4.5±3.1) years; 229 males, 240 females) underwent salivagram. Signed informed consents were obtained. 99Tcm-SC (11.1 MBq, 100 μl) was dropped into the root of tongue. After the dropping, the posterior dynamic acquisition was started for 60 min, and then the anterior and posterior static images were acquired for 5 min. All patients were followed up for 3-6 months after the salivagram, and the salivagram results were analyzed. If radioactivity was shown in the main bronchus or bilateral lung fields, the Pulmonary Aspiration was diagnosed. Results Salivagram demonstrated positive results in 20.7% (97/469) of the patients. However, 3 patients with Pulmonary Aspiration showed negative results. There was no false positive result on salivagram. Conclusion Salivagram shows good results in the diagnosis of pediatric Pulmonary Aspiration. Key words: Pneumonia, Aspiration; Child; Radionuclide imaging; Saliva; Technetium; Sulfur colloid
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radionuclide salivagram and gastroesophageal reflux scintigraphy in pediatric patients targeting different types of Pulmonary Aspiration
Clinical Nuclear Medicine, 2015Co-Authors: Jigang Yang, Ion Codreanu, Sabah Servaes, Hongming ZhuangAbstract:OBJECTIVE: Both gastroesophageal reflux (GER) scintigraphy and radionuclide salivagram are commonly used in the detection of Pulmonary Aspiration in pediatric patients. This investigation is to compare the diagnostic value of these 2 imaging methods. METHODS: This retrospective study included 4186 pediatric patients (aged 1 week to 16 years; mean age, 28 months) who underwent a GER scintigraphy and/or radionuclide salivagram. Detection rate of Pulmonary Aspiration by the 2 imaging techniques was compared. RESULTS: The detection rate for Pulmonary Aspiration in patients undergoing both procedures was 1.9% (5 of 266) for GER scintigraphy and 22.2% (59 of 266) for radionuclide salivagram. Fifty-six of 59 patients with proven Aspiration on radionuclide salivagram demonstrated no such findings on GER scintigraphy, whereas 2 of 5 patients with proven Aspiration on GER scintigraphy demonstrated no such findings on radionuclide salivagram. In patients who underwent only 1 procedure (either GER scintigraphy or salivagram), the detection rate for Pulmonary Aspiration was 0.4% (15 of 3551) for GER scintigraphy and 20.3% (75 of 369) for radionuclide salivagram. CONCLUSIONS: Radionuclide salivagram showed a much higher detection rate for Pulmonary Aspiration compared with GER scintigraphy. However, this may be related to a significantly higher prevalence of antegrade versus retrograde Aspiration in our study population. Our results also suggest that not all episodes of retrograde Aspiration can be detected by a radionuclide salivagram, and the requested scan should be tailored to the type of suspected Aspiration.
Stephen Graham - One of the best experts on this subject based on the ideXlab platform.
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Prone ventilation following witnessed Pulmonary Aspiration: the effect on oxygenation
Intensive Care Medicine, 2003Co-Authors: Jason Easby, Babu K. Abraham, Stephen M. Bonner, Stephen GrahamAbstract:Objective Pulmonary Aspiration is a significant cause of admission to the ITU and is associated with significant morbidity and mortality. Aspiration in the supine position produces posterior collapse/consolidation, similar to that seen in ALI/ARDS patients. Prone positioning has been shown to improve oxygenation in ALI/ARDS, but no studies have been performed on Pulmonary Aspiration. Design A prospective crossover study. Setting Twelve-bed ITU. Patients and participants Eleven patients admitted to ITU with respiratory failure secondary to witnessed Pulmonary Aspiration requiring ventilation and an FIO_2 >0.50 after 12 h. Interventions Patients were placed in a prone position for 8 h and then turned supine for 8 h. Prone positioning was repeated if the FIO_2 remained >0.50. Ventilator settings were not altered in the study period. Measurements and results Arterial blood gas analysis was performed every 2 h. The PaO_2/FIO_2 gradient was calculated. Oxygenation improved on turning prone, with a significant increase in the PaO_2/FIO_2 ratio ( P
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Prone ventilation following witnessed Pulmonary Aspiration: the effect on oxygenation.
Intensive Care Medicine, 2003Co-Authors: Jason Easby, Babu K. Abraham, Stephen Bonner, Stephen GrahamAbstract:Objective Pulmonary Aspiration is a significant cause of admission to the ITU and is associated with significant morbidity and mortality. Aspiration in the supine position produces posterior collapse/consolidation, similar to that seen in ALI/ARDS patients. Prone positioning has been shown to improve oxygenation in ALI/ARDS, but no studies have been performed on Pulmonary Aspiration.
Lilibeth A. Pineda - One of the best experts on this subject based on the ideXlab platform.
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Triggering receptors expressed on myeloid cells in Pulmonary Aspiration syndromes
Intensive Care Medicine, 2008Co-Authors: Ali A. El Solh, Morohunfolu E. Akinnusi, Misha Peter, Ilya Berim, Marcus J. Schultz, Lilibeth A. PinedaAbstract:To investigate the potential role of serum and alveolar soluble triggering receptor expressed on myeloid cells (sTREM-1) as a biological marker of Pulmonary Aspiration syndromes. Prospective cohort study. University-affiliated intensive care unit. Seventy-five patients with Pulmonary Aspiration and 13 controls receiving mechanical ventilation. Blood and bronchoalveolar lavage (BAL) fluid samples were collected on enrollment. Soluble TREM-1 levels were measured by an enzyme-linked immunosorbent assay. Thirty-eight of 75 participants had documented BAL culture-positive Pulmonary Aspiration. While circulating levels of sTREM-1 were comparable between those with Aspiration syndromes (19.81 ± 12.09 pg/ml) and controls (15.96 ± 11.16 pg/ml) (p = 0.27), the alveolar levels of sTREM-1 were higher in patients with culture-positive Pulmonary Aspiration (344.41 ± 152.82 pg/ml) compared with those culture-negative Pulmonary Aspiration (142.76 ± 89.88 pg/ml; p
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triggering receptors expressed on myeloid cells in Pulmonary Aspiration syndromes
Intensive Care Medicine, 2008Co-Authors: Ali A. El Solh, Morohunfolu E. Akinnusi, Misha Peter, Ilya Berim, Marcus J. Schultz, Lilibeth A. PinedaAbstract:To investigate the potential role of serum and alveolar soluble triggering receptor expressed on myeloid cells (sTREM-1) as a biological marker of Pulmonary Aspiration syndromes. Prospective cohort study. University-affiliated intensive care unit. Seventy-five patients with Pulmonary Aspiration and 13 controls receiving mechanical ventilation. Blood and bronchoalveolar lavage (BAL) fluid samples were collected on enrollment. Soluble TREM-1 levels were measured by an enzyme-linked immunosorbent assay. Thirty-eight of 75 participants had documented BAL culture-positive Pulmonary Aspiration. While circulating levels of sTREM-1 were comparable between those with Aspiration syndromes (19.81 ± 12.09 pg/ml) and controls (15.96 ± 11.16 pg/ml) (p = 0.27), the alveolar levels of sTREM-1 were higher in patients with culture-positive Pulmonary Aspiration (344.41 ± 152.82 pg/ml) compared with those culture-negative Pulmonary Aspiration (142.76 ± 89.88 pg/ml; p < 0.001). A cut-off value of 250 pg/ml for alveolar sTREM-1 achieved a sensitivity of 65.8% (95% CI 48.6–80.4) and a specificity of 91.9% (95% CI 78.1–98.2) with an area under the curve of 0.87 (95% CI 0.78–0.94). Alveolar sTREM-1 levels can be a potential biomarker for distinguishing BAL culture-positive from BAL culture-negative Pulmonary Aspiration.
