Lipoid Pneumonia Caused by Diesel Aspiration: A Case Report and Literature Review

Diesel poisoning is a rare clinical condition.On September 27,2021,a 55-year-old male who mistakenly inhaled 20 mL of diesel through a siphon was admitted to our hospital.The main symptoms were cough and asthma.Chest computed tomography(CT)showed both lungs scattered with patchy consolidation,ground-glass shadow,exudation,and pleural effusion.After 61 days of lung rehabilitation training and other supportive treatment,including oxygen therapy,postural drainage,ventilator support,bronchoalveolar lavage,hemoperfusion,continuous renal replacement therapy(CRRT),hormones,and antibiotics,the patient’s condition improved,and the patient was discharged.Through literature review,we found that lung consolidation,ground-glass shadow,nodular lesions,and pleural effusion can be observed on chest images of patients with lipoid pneumonia,with severe cases showing diffuse lesions involving both lungs,possibly secondary to respiratory failure.Children with acute critical illness deteriorates rapidly and have poor prognosis,whereas adults or patients with chronic poisoning have better prognosis after active treatment.

Aspiration pneumonia during general anesthesia induction after esophagectomy: A case report

BACKGROUND Esophageal cancer is a common malignant tumor of the digestive system.At present,surgery is the most important treatment strategy.After esophagectomy and gastric esophagoplasty,the patients are prone to regurgitation.However,these patients currently do not receive much attention,especially from anesthesiologists.CASE SUMMARY A 55-year-old woman was scheduled for right lower lung lobectomy.The patient had undergone radical surgery for esophageal cancer under general anesthesia 6 mo prior.Although the patient had fasted for>17 h,unexpected aspiration still occurred during induction of general anesthesia.Throughout the operation,oxygen saturation was 98%-100%,but the airway pressure was high(35 cmH2O at double lung ventilation).The patient was sent to the intensive care unit after surgery.Bedside chest radiography was performed,which showed exudative lesions in both lungs compared with the preoperative image.After surgery,antibiotics were given to prevent lung infection.On day 2 in the intensive care unit,the patient was extubated and discharged on postoperative day 7 without complications related to aspiration pneumonia.CONCLUSION After esophagectomy,patients are prone to regurgitation.We recommend nasogastric tube placement followed by rapid sequence induction or conscious intubation.

Effect of Feeding Management on Aspiration Pneumonia in Elderly Patients with Dysphagia

Objective： To investigate the effects of feeding safety instructions and dietary intervention on aspiration pneumonia in elderly patients with dysphagia. Methods： The study included 40 long-term hospitalized elderly patients with dysphagia who needed oral intake, According to the voluntary and matching principle, participants were divided into the intervention group （n =20） and control group （n = 20）. We formed a multi-disciplinary team including clinical nurses, rehabilitation therapists and nutritionists. Clinical nurses collaborated with nutritionists and rehabilitation therapists to carry out feeding management. The patients in the control group were fed with semi-solid food, thick liquid, a partial mushy diet and so on according to their swallowing situations and tastes or preferences. The patients in the intervention group were fed with an all mushy diet. Patients in both groups were able to eat foods on their own or with assistance. Results： After a three-month intervention, the incidence of aspiration pneumonia in both groups was decreased, and the difference was statistically significant （P〈0.05）. In the control group, seven patients had aspiration pneumonia, including two cases who died after nasogastric feeding due to aggravated dysphagia. In the control group, seven patients had aspiration pneumonia, including two cases was given nasogastric feeding due to aggravated dysphagia and then one case died. In the intervention group, four patients had aspiration pneumonia. There was no dropouts in either group. Conclusions： Elderly patients with dysphagia require a multidisciplinary team to work closely with them to carry out feeding management. Nurses should conduct safety guidance for care catering and encouraging patients to actively eat a mushy diet. The diet can reduce the incidence of aspiration pneumonia, maintain oral intake and improve the quality of life.

Capacity of the Pectoralis Major Muscle May Be a Prognostic Factor for Aspiration Pneumonia

Objective: Aspiration pneumonia is thought to be caused by a decline in respiratory and swallowing function. We aimed to clarify whether the pectoralis major muscle and the rectus abdominis muscles are prognostic factors for aspiration pneumonia and to investigate the relationships between these muscles and nutritional status, swallowing function and sarcopenia, Methods: Medical records of 139 Japanese patients hospitalized for aspiration pneumonia between December 2010 and December 2014 were reviewed retrospectively. The volume and thickness of the pectoralis major muscle, the crosssectional area and thickness of the rectus abdominis muscles, and cross-sectional area of the psoas major muscle were measured using computed tomography. Swallowing function, nutritional status, activities of daily living, and prognosis also were evaluated. Results: The volume [Median: (left) 4713.2 mm3 vs. 4232.6 mm3 (right) 4981.7 mm3 vs. 4362.6 mm3 p < 0.05] and thickness [Median: (left) 6.9 mm vs. 4.6 mm (right) 7.3 mm vs. 5.7 mm p < 0.01] of the pectoralis major muscle and thickness of the right rectus abdominis muscles [Median: 7.3 mm vs. 5.8 mm p < 0.05] were significantly larger, while Mini-Nutritional Assessment Short Form (MNA-SF) [Median: 6.0 vs. 4.0 p < 0.01] and Functional Oral Intake Scale (FOIS) [Median: 3 vs. 1 p < 0.01] scores were significantly higher in patients who survived. The volume [Median: (left) 5789.1 mm3 vs. 3706.5 mm3 (right) 5650.3 mm3 vs. 4003.7 mm3 p < 0.01] and thickness [Median: (left) 7.1 mm vs. 5.9 mm p < 0.05] of the pectoralis major muscle and cross-sectional area of the psoas major muscle (left and right) [Median: (left) 500.1 mm2 vs. 432.0 mm2 (right) 563.5 mm2 vs. 446.3 mm2 p < 0.01] were significantly larger, while albumin levels [Median: 3.8 g/dl vs. 3.4g/dl p < 0.01] and MNA-SF [Median: 6.0 vs. 5.0 p < 0.01] and FOIS [Median: 4 vs. 1 p < 0.01] scores were significantly higher in patients with coexisting diseases. Conclusion: The capacity of the pectoralis major muscle may be an independent factor in the prognosis of elderly patients with aspiration pneumonia as a primary disease.

Effects of Semi-Solid Enteral Formula on Aspiration Pneumonia and Diarrhea

Objective: The effects of semi-solid enteral formula were investigated in tube feeding patients with aspiration pneumonia and/or diarrhea caused by liquid enteral formula. Methods: In 25 cases of aspiration pneumonia and 10 cases of diarrhea (5 cases had both aspiration pneumonia and diarrhea) caused by liquid enteral formula, the rate of improvement by changing the liquid enteral formula to semi-solid enteral formula was studied. The semi-solid enteral formula (PG Soft&reg;EJ) was infused via the nasogastric tube (16Fr) or percutaneous endoscopic gastrostomy (PEG) tube (20Fr). Results: The semi-solid enteral formula was effective in 72% of aspiration pneumonia cases and in 80% of diarrhea cases. Constipation was observed in one case but was controlled with magnesium oxide. Conclusion: In cases of aspiration pneumonia and/or diarrhea, changing liquid enteral formula to semi-solid enteral formula frequently shows improvement.

Severe aspiration pneumonia in the elderly

The global population is aging at an unprecedented rate,resulting in a growing and vulnerable elderly population in need of efficient comprehensive healthcare services that include long-term care and skilled nursing facilities.In this context,severe aspiration pneumonia,a condition that carries substantial morbidity,mortality,and financial burden,especially among elderly patients requiring admission to the intensive care unit,has attracted greater concern.Aspiration pneumonia is defined as a pulmonary infection related to aspiration or dysphagia in etiology.Prior episodes of coughing on food or liquid intake,a history of relevant underlying conditions,abnormalities on videofluoroscopy or water swallowing,and gravity-dependent shadow distribution on chest imaging are among the clues that suggest aspiration.Patients with aspiration pneumonia tend to be elderly,frail,and suffering from more comorbidities than those without this condition.Here,we comprehensively address the epidemiology,clinical characteristics,diagnosis,treatment,prevention,and prognosis of severe aspiration community-acquired pneumonia in the elderly to optimize care of this high-risk demographic,enhance outcomes,and minimize the healthcare costs associated with this illness.Emphasizing preventive measures and effective management strategies is vital in ensuring the well-being of our aging population.

Efficacy of budesonide/formoterol inhalation powder in treating viral pneumonia in children

BACKGROUND Respiratory viruses are increasingly detected in children with communityacquired pneumonia.Further strategies to limit antibiotic use in children with viral pneumonia are warranted.AIM To explore clinical efficacy of budesonide/formoterol inhalation powder for viral pneumonia in children and its impact on cellular immunity and inflammatory factor production.METHODS A total of 60 children with viral pneumonia were recruited:30 receiving budesonide/formoterol inhalation powder and 30 conventional symptomatic treatment.Outcome measures included peripheral blood levels of inflammatory cytokines,CD4^(+),CD8^(+),Th1,Th2,Th17 and Treg,clinical efficacy,and incidence of adverse reactions.RESULTS Compared with the control group,the observation group showed a significant reduction in interleukin-6 and high-sensitivity C-reactive protein levels after treatment.Compared with the control group,the observation group showed a significant increase in CD4^(+)/CD8^(+)and Th1/Th2 levels,and a decrease in Th17/Treg levels after treatment.The total effective rates in the observation group and the control group were 93.75%and 85.00%,respectively,which was a significant difference(P=0.003).CONCLUSION Budesonide/formoterol inhalation powder significantly improved therapeutic efficacy for viral pneumonia in children.The mechanism of action may be related to downregulation of the inflammatory response and improved cellular immune function.

Correlation of serum nutrient levels with immune cell differentiation and inflammatory response activation in children with pneumonia

Objective:To investigate the correlation of serum nutrient levels with immune cell differentiation and inflammatory response activation in children with pneumonia.Methods:200 children with pneumonia who were treated in our hospital between April 2015 and August 2017 were selected as the pneumonia group, and 100 healthy children who were vaccinated in this hospital during the same period were selected as the normal control group. The differences in serum levels of nutrients, Th1/Th2 cytokines, Th17/Treg cytokines and inflammatory mediators were compared between the two groups. Pearson test was used to assess the relationship between serum nutrient levels and disease severity.Results: Serum Vit A, Fe and Zn levels of pneumonia group were lower than those of control group. The differences in serum Vit D, Ca and Mg levels were not statistically significant between the two groups of children. Serum Th1 cytokines IL-2 and TNF-β contents of pneumonia group were lower than those of control group whereas Th2 cytokines IL-4 and IL-5 contents were higher than those of control group;Th17 cytokines IL-17, IL-21 and IL-22 contents were higher than those of control group whereas Treg cytokines IL-10 and TGF-β contents were lower than those of control group;inflammatory mediators CRP, PCT and MCP-1 contents were significantly higher than those of control group. Pearson test showed that serum nutrients Vit A, Fe and Zn levels in children with pneumonia were directly correlated with the degree of immune cell differentiation and inflammatory response.Conclusion: Serum Vit A, Fe, Zn and other nutrient levels abnormally decrease in children with pneumonia, and the specific level are directly correlated with the severity of the disease.

Multidisciplinary approach to suspected sudden unexpected infant death caused by milk-aspiration:A case report

BACKGROUND The term sudden unexpected infant death(SUID)is not always properly invoked.It refers to a broad range of conditions that sometimes defy classification.There is not only a strong emotional impact on the family,but such cases are also quite complex.Underlying causes may be multiple,not always readily apparent,and have potential repercussions,especially in terms of forensics.CASE SUMMARY A 5-month-old male baby was pronounced dead following acute lung failure and cardiopulmonary arrest.The parents had immediately rushed their child to the hospital,stating the baby was found prone and not breathing.Total-body postmortem computed tomography(PMCT)was performed,revealing a hypodense material of indeterminate nature within the main airways and areas of ground-glass parenchymal change.At autopsy,the respiratory tract mucosa appeared edematous and was coated with a whitish stringy material.There was widespread airspace reduction due to parenchymal collapse.Alveolar sacs and bronchial openings contained abundant amorphous material admixed with white blood cells.Immunohistochemical studies were performed,targeting CD15,CD68,and alpha-lactalbumin.Ultimately,the focus was on alpha-lactalbumin(milk protein),which showed marked immunopositivity within alveolar spaces.Cytoplasmic staining of macrophages was also particularly prominent.CONCLUSION Postmortem investigations are thus essential to identify causes of death and surrounding circumstances.PMCT is a useful tool in this setting,given the frequent dearth of autopsy findings and ambiguity as to cause of death in SUID cases.These findings,later confirmed by immunohistochemical investigations,were indicative of active pneumonia due to aspirated milk.The present account illustrates the importance a broad diagnostic approach to SUID in cases of forensic concern.PMCT is a very valuable aid in cases of forensic interest,as it can provide useful information in all those situations in which the cause of death is uncertain or there are no suggestive dynamics or lesions.

抗Th/To抗体阳性间质性肺炎急性加重报道1例并文献复习

目的分享1例抗Th/To抗体阳性间质性肺炎急性加重的临床表现及诊治经过,了解抗Th/To抗体的临床意义,为临床诊疗提供参考。方法收集1例抗Th/To抗体阳性间质性肺炎急性加重患者的临床资料,包括患者的性别、年龄等一般信息以及临床表现、实验室检查和影像学特点;结合文献复习,对临床资料进行分析。结果患者女,75岁,因“胸闷气喘7 d”于2023年7月31日收治入院。胸部HRCT显示间质性肺炎,ANA 1︰320,ENA(-),抗中性粒细胞抗体PANCA(甲醛敏感)(+),唇腺活检病理(-),肌炎抗体谱提示Th/To抗体阳性,查体面部、上肢皮肤色深,技工手,无明显皮肤硬化表现,四肢肌力正常,考虑结缔组织疾病相关间质性肺炎急性加重。予糖皮质激素联合环磷酰胺治疗后逐渐好转出院。结论抗Th/To抗体是一种核仁抗体,阳性患者常见于局限性硬皮病,内脏受累较轻,但常伴有间质性肺炎和肺动脉高压。对于间质性肺炎患者可积极完善肌炎抗体谱检查,在充分评估患者病情后慎重选择支气管镜检查。

Aberrant Th2 inflammation drives dysfunction of alveolar macrophages and susceptibility to bacterial pneumonia

The ubiquitin ligase,Itch,is required to prevent autoinflammatory disease in mice and humans.Itch-deficient mice develop lethal pulmonary inflammation characterized by the production of Th2 cytokines(for example,interleukin-4(IL-4));however,the contribution of Itch to immune defense against respiratory pathogens has not been determined.We found that Itch-deficient mice were highly susceptible to intranasal infection with the respiratory pathogen Klebsiella pneumoniae.Infected Itch-deficient mice exhibited increased immune cell infiltration,cytokine levels and bacterial burden in the respiratory tract compared with control mice.However,numbers of resident alveolar macrophages were reduced in the lungs from Itch-deficient mice both before and after infection.High levels of Th2 cytokines in the respiratory tract correlated with deceased alveolar macrophages,and genetic ablation of IL-4 restored alveolar macrophages and host defense to K.pneumoniae in Itch-deficient mice,suggesting that loss of alveolar macrophages occurred as a consequence of Th2 inflammation.Adoptive transfer of Itch−/−CD4+T cells into Rag−/−mice was sufficient to drive reduction in numbers of Itch-replete alveolar macrophages.Finally,we found that Stat6 signaling downstream of the IL-4 receptor directly reduced fitness of alveolar macrophages when these cells were exposed to the Itch−/−inflamed respiratory tract.These data suggest that Th2 inflammation directly impairs alveolar macrophage fitness in Itch−/−mice,and elucidate a previously unappreciated link between Th2 cells,alveolar macrophages and susceptibility to bacterial infection.

匹多莫德联合布地奈德治疗MPP的疗效及对Th1/Th2平衡的影响

支原体肺炎（mycoplasma pneumoniae pneumonia,MPP）是儿童时期急性重症之一.近年来研究表明,Th1/Th2细胞平衡紊乱是其重要的发病机制[1-2].本文采用匹多莫德联合布地奈德治疗MPP患儿,通过观察MPP患儿治疗前后外周抗凝血分离单个核细胞（PBMC）培养液中自介素-4（IL-4）和γ-干扰素（IFN-γ）的含量变化,探讨匹多莫德联合布地奈德治疗MPP的临床疗效,及其对MPP患儿Th1/Th2平衡的影响,现报道如下.

注射用乌司他丁联合纤维支气管镜吸痰治疗重症肺炎的疗效及对患者血清sTREM-1、sCD163的影响

目的:探究注射用乌司他丁联合纤维支气管镜吸痰治疗重症肺炎的疗效及对患者血清sTREM-1、sCD163的影响。方法:选取2020年6月至2023年6月滨州医学院附属医院收治的重症肺炎患者为研究对象。将符合排纳标准的92例重症肺炎患者随机分为对照组(n=46)和联合组(n=46)。对照组在常规治疗基础上行纤维支气管镜吸痰,联合组在对照组的基础上加用乌司他丁。观察两组患者的炎性因子水平(PCT、TNF-α、CRP)及sTREM-1、sCD163水平、血气分析指标(血氧分压和氧合指数)、临床疗效。结果:(1)治疗前,两组炎性因子水平对比(P>0.05),治疗后,联合组的炎性因子水平(TNF-α、CRP、PCT)均低于对照组(P<0.05)。(2)治疗前,两组血清sTREM-1、sCDl63水平对比(P>0.05),治疗后,联合组的血清sTREM-1、sCDl63水平均低于对照组(P<0.05)。(3)治疗前,两组血氧分压、氧合指数对比(P>0.05),治疗后,联合组的血氧分压、氧合指数均低于对照组(P<0.05)。(4)联合组的有效率为95.65%高于对照组的82.61%(P<0.05)。结论:注射用乌司他丁联合纤维支气管镜吸痰可有效改善重症肺炎患者的炎性因子水平、血气分析指标、临床疗效。

早期摄食训练监测在缺血性脑卒中伴吞咽障碍病人中的应用

目的:探究早期摄食训练监测在缺血性脑卒中伴吞咽障碍病人中的应用效果。方法:选取2022年2月—2023年3月在长春市某三级甲等医院脑病中心住院接受治疗的缺血性脑卒中伴吞咽障碍病人126例为研究对象,采用随机数字表法将病人分为两组,对照组63例,干预组63例。对照组给予常规康复训练护理方案,干预组在对照组基础上实施早期摄食训练监测。比较两组吞咽功能等级、吞咽功能恢复情况、口咽性吞咽障碍、误吸及吸入性肺炎发生率、住院天数、胃管拔除后再插管率。结果:干预组吞咽功能等级低于对照组,总有效率高于对照组(P<0.05);干预组误吸发生率为3.17%,对照组为25.40%,干预组低于对照(P<0.05);干预组吸入性肺炎发生率为6.35%,对照组吸入性肺炎发生率为20.63%,干预组低于对照(P<0.05);干预组口咽性吞咽障碍情况优于对照组(P<0.05)。结论:早期摄食训练监测对于改善缺血性脑卒中伴吞咽障碍病人吞咽功能、降低病人误吸及吸入性肺炎发生率具有积极意义。

小儿支原体肺炎中医证候与TH细胞相关性研究

目的探讨TH1、TH2、TH17的效应因子干扰素-γ(IFN-γ)、白细胞介素(IL)-4、IL-17与小儿肺炎支原体肺炎(MPP)中医证型的关系。方法选取55例MPP住院患儿,根据症状体征进行中医辨证分型,检测血清IFN-γ、IL-4、IL-17含量,与33例正常组儿童进行比较。结果 55例MPP中,风热闭肺证25例,痰热闭肺证3例,痰瘀互阻证11例,脾虚痰蕴证16例。MPP患儿血清IFN-γ、IL-4、IL-17较正常组儿童均升高,IL-4、IL-17显著升高(均P<0.01),IFN-γ升高无统计学意义。痰热闭肺证的血清IFN-γ、IL-4含量均高于其余3组(P<0.01);脾虚痰蕴证IL-4低于其余3组(P<0.01);IL-17含量各证型之间差异无统计学意义。结论 MPP患儿中医证候与TH细胞具有相关性,可为不同证型分期论治提供较客观的免疫学指标。

脑卒中患者隐性误吸风险管理研究进展

从脑卒中患者发生隐性误吸的风险因素(年龄、吞咽障碍、意识障碍、疾病与治疗性因素、机械通气、气管插管与气管切开、照护因素)、不良结局(吸入性肺炎、营养不良与恐惧)及防范措施(吞咽功能康复训练、营养管理、集束化护理、知识与技能培训)三方面进行综合论述,旨在为护理人员更好地护理脑卒中患者、预防隐性误吸提供参考。

急性缺血性脑卒中患者住院期间吸入性肺炎风险评分构建与验证

目的 探讨急性缺血性脑卒中(AIS)患者住院期间发生吸入性肺炎的危险因素,并构建AIS患者住院期间发生吸入性肺炎风险的预测模型。方法 收集温州医科大学附属第二医院因AIS入院患者的临床资料。用单因素、多因素Logistic回归分析,筛选出发生吸入性肺炎的相关危险因素,并构建预测模型。结果 高龄、入院时GCS评分低、既往卒中病史、糖尿病史、吞咽障碍及低白蛋白血症是AIS患者住院期间并发吸入性肺炎危险因素。该模型预测吸入性肺炎发生风险的ROC曲线下面积(AUC)为0.831(0.786~0.876),内部验证预测吸入性肺炎发生风险的AUC为0.827(0.782~0.873)。Hosmer-Lemeshow检验:χ^(2)=12.585,P=0.127。结论 本预测模型具有良好的区分度与校准度,有助于临床医师评估AIS中患者住院期间发生吸入性肺炎风险。

自由饮水训练在吞咽障碍患者中应用的研究进展

文章对自由饮水训练的概念、适用人群、训练原则和方法以及自由饮水在吞咽障碍患者中的应用效果等进行了综述,以期为自由饮水训练在吞咽康复领域的研究提供参考.

Gastroesophageal reflux disease and the airway-essentials for the surgeon

Gastroesophageal reflux disease(GERD) has many protean manifestations.Some of the most vexing have to do with the airway.GERD affects the tracheobronchial tree directly,leading to aspiration pneumonia and asthma,or exacerbating existing pulmonary disease,such as asthma or chronic obstructive pulmonary disease.In addition to the respiratory manifestation of GERD,there are unique pharyngeal and laryngeal manifestations.These include voice hoarseness,throat-clearing,chronic cough,globus,and "post-nasal drip".Linking these symptoms to GERD is challenging and frequently the diagnosis is that of exclusion.Despite proton pump inhibitor therapy being the mainstay of treatment,with anti-reflux surgery being reserved for intractable cases,there is no definitive evidence of the superiority of either.

成人危重症患者误吸预防与管理的最佳证据总结

目的 系统检索、评价及整合成人危重症患者误吸预防与管理的相关证据,并汇总形成最佳证据,为误吸的预防与管理提供依据。方法 遵照“6S”金字塔模型,自上而下系统检索BMJ Best Practice,UpToDate,澳大利亚乔安娜布里格斯研究所循证卫生保健中心数据库,加拿大安大略省注册护士协会,国际指南协作网,美国指南网,英国国家卫生与临床优化研究所,苏格兰校际指南网,PubMed,Embase,Cochrane Library,CINAHL,中国临床指南文库,医脉通,中国生物医学文献数据库,中国知网,万方数据库和维普数据库。纳入有关危重症患者误吸预防与管理的临床决策、指南、证据总结、专家共识/专家推荐、系统评价/Meta分析、随机对照试验,检索时限为2013年1月至2023年8月。由2名接受过循证护理学培训的研究者独立进行文献筛选、质量评价、证据提取与整合。结果 共纳入33篇研究,包括临床决策4篇、指南4篇、证据总结5篇、专家共识8篇、系统评价/Meta分析9篇、随机对照试验3篇。涉及误吸风险评估、气道管理、口腔卫生管理、体位管理、肠内营养管理、药物管理与干预、拔管后误吸的预防、误吸的诊断与处理、误吸培训与团队管理9个方面,共36条证据。结论 该证据总结可为医护人员对危重症患者误吸的预防及管理工作提供循证依据,促进ICU误吸的科学、规范化管理。