Document Detail


Physiology of the aerodigestive system and aberrations in that system resulting in aspiration.
MedLine Citation:
PMID:  12405618     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Aspiration pneumonia remains a significant and often devastating problem in critically ill patients. It is unclear whether aspiration pneumonia occurs because of problems in the handling of oropharyngeal secretions or if the reflux of gastric contents is the major etiological factor. Additionally, the obvious breakdown of upper aerodigestive protective mechanisms in the critically ill patient population is largely unstudied. Finally, the impact and contribution of tubes, both endotracheal and nasoenteral, on aspiration pneumonia is unclear. METHODS: A Medline literature search on scientific and review articles concerning the normal physiology of the aerodigestive tract and factors that compromised normal physiology was undertaken. Readings were supplemented by expert outside opinion from researchers in these fields and from the combined expertise from a multidisciplinary panel of experts assembled at a recent summit on aspiration pneumonia. RESULTS: Changes in the normal physiology of the aerodigestive tract are vast and varied and dependent on the response to injury, iatrogenic interventions, and the use of nasoenteral and endotracheal tubes. The effects on gastric and esophageal motility are likely dynamic and represent an ongoing but changing risk of reflux for the patient. Nasoenteral and endotracheal tubes likely compromise upper aerodigestive protective mechanisms. CONCLUSIONS: More research is needed on the functioning of the aerodigestive protective mechanisms in critically ill patients. Understanding of the dynamic changes in gastrointestinal motility will also be an important factor to decrease the incidence of aspiration pneumonia in this patient population.
Authors:
Mark T DeMeo; Keith Bruninga
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  JPEN. Journal of parenteral and enteral nutrition     Volume:  26     ISSN:  0148-6071     ISO Abbreviation:  JPEN J Parenter Enteral Nutr     Publication Date:    2002 Nov-Dec
Date Detail:
Created Date:  2002-10-30     Completed Date:  2003-03-25     Revised Date:  2007-02-21    
Medline Journal Info:
Nlm Unique ID:  7804134     Medline TA:  JPEN J Parenter Enteral Nutr     Country:  United States    
Other Details:
Languages:  eng     Pagination:  S9-17; discussion S17-8     Citation Subset:  IM    
Affiliation:
Department of Medicine, Rush University Medical Center, Chicago, Illinois 60612-3824, USA. mark_t_demeo@rush.edu
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MeSH Terms
Descriptor/Qualifier:
Digestive System / physiopathology*
Digestive System Diseases / physiopathology*
Humans
Inhalation / physiology*
Pneumonia, Aspiration / etiology*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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