Seminars in respiratory and critical care medicine最新文献

Safety, Efficacy, and Effectiveness of Maternal Vaccination against Respiratory Infections in Young Infants.

IF 2.3 3区医学

Seminars in respiratory and critical care medicine Pub Date : 2024-12-21 DOI: 10.1055/a-2471-6906

Nisha Makan-Murphy, Shabir A Madhi, Ziyaad Dangor

引用次数: 0

Advances in Disease-Modifying Therapeutics for Chronic Neuromuscular Disorders.

IF 2.3 3区医学

Seminars in respiratory and critical care medicine Pub Date : 2024-12-21 DOI: 10.1055/a-2463-3385

Long Davalos, Hani Kushlaf

{"title":"Advances in Disease-Modifying Therapeutics for Chronic Neuromuscular Disorders.","authors":"Long Davalos, Hani Kushlaf","doi":"10.1055/a-2463-3385","DOIUrl":"https://doi.org/10.1055/a-2463-3385","url":null,"abstract":"Neuromuscular disorders can cause respiratory impairment by affecting the muscle fibers, neuromuscular junction, or innervation of respiratory muscles, leading to significant morbidity and mortality. Over the past few years, new disease-modifying therapies have been developed and made available for treating different neuromuscular disorders. Some of these therapies have remarkable effectiveness, resulting in the prevention and reduction of respiratory complications. For myasthenia gravis (MG), efgartigimod, ravulizumab, rozanolixizumab, and zilucoplan have been Food and Drug Administration (FDA)-approved for the treatment of acetylcholine receptor (AChR) antibody-positive generalized MG in the past 2 years. Rozanolixiumab is also approved for treating MG caused by muscle-specific tyrosine kinase (MuSK) antibodies. The new MG therapeutics target the complement system or block the neonatal fragment crystallizable (Fc) receptors (FcRn), leading to significant clinical improvement. For spinal muscular atrophy (SMA), nusinersen (intrathecal route) and risdiplam (oral route) modify the splicing of the SMN2 gene, increasing the production of normal survival motor neuron (SMN) protein. Onasemnogene abeparvovec is a gene replacement therapy that encodes a functional SMN protein. All SMA medications, particularly onasemnogene abeparvovec, have led to clinically meaningful improvement. For late-onset Pompe disease (LOPD), avalglucosidase alfa has shown a greater improvement in respiratory function, ambulation, and functional outcomes in comparison to alglucosidase alfa, and cipaglucosidase alfa combined with miglustat has shown improvement in respiratory and motor function in a cohort of enzyme replacement therapy-experienced LOPD patients. Amyotrophic lateral sclerosis (ALS) remains a challenge. The two most recent FDA-approved medications, namely sodium phenylbutyrate and tofersen, may slow down the disease by a few months in a selected population but do not stop the progression of the disease.","PeriodicalId":21727,"journal":{"name":"Seminars in respiratory and critical care medicine","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142872912","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Vaccination Against Respiratory Infections in the Immunosenescent Elderly: challenges and opportunities.

IF 2.3 3区医学

Seminars in respiratory and critical care medicine Pub Date : 2024-12-11 DOI: 10.1055/a-2500-2121

Fiona Ecarnot, Stefania Maggi

引用次数: 0

Is There a Role for Bronchoscopy in Aspiration Pneumonia? 支气管镜对吸入性肺炎有作用吗？

IF 2.3 3区医学

Seminars in respiratory and critical care medicine Pub Date : 2024-12-01 Epub Date: 2024-10-24 DOI: 10.1055/s-0044-1791739

Andrei M Darie, Daiana Stolz

{"title":"Is There a Role for Bronchoscopy in Aspiration Pneumonia?","authors":"Andrei M Darie, Daiana Stolz","doi":"10.1055/s-0044-1791739","DOIUrl":"10.1055/s-0044-1791739","url":null,"abstract":"Aspiration represents the passage of oropharyngeal content to the lower respiratory tract. The interplay between the host and the aspirate proprieties determines the subsequent aspiration syndrome. A low pH, typical of gastric aspirate, favors chemical pneumonitis, whereas an increased bacterial inoculum causes aspiration pneumonia. About a quarter of patients with aspiration pneumonitis will develop a bacterial superinfection during the course of recovery. While antibiotic therapy is indicated for aspiration pneumonia, supportive care remains the cornerstone of treatment in aspiration pneumonitis. However, the overlapping clinical features of these syndromes lead to initiation of antimicrobial therapy in most cases of aspiration. Bronchoscopy can aid in clinical decision-making by direct airway visualization and also by providing access to a series of emerging biomarkers. Invasive microbiological studies increase diagnostic yield and enable a tailored antibiotic treatment. In conjunction with stewardship programs, invasive sampling and novel molecular diagnostics can decrease the amount of inappropriate antibiotic therapy. In the context of foreign body aspiration, bronchoscopy represents both diagnostic and treatment gold standard.","PeriodicalId":21727,"journal":{"name":"Seminars in respiratory and critical care medicine","volume":" ","pages":"650-658"},"PeriodicalIF":2.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142507456","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Therapy of Aspiration: Out-of-Hospital and In-Hospital-Acquired. 吸入治疗：院外和院内获得性吸入。

IF 2.3 3区医学

Seminars in respiratory and critical care medicine Pub Date : 2024-12-01 Epub Date: 2024-10-25 DOI: 10.1055/s-0044-1791826

Di Pan, Bradley Isaacs, Michael S Niederman

引用次数: 0

Bacteriology of Aspiration Pneumonia: The Lung Microbiome and the Changing Microbial Etiology. 吸入性肺炎的细菌学：肺部微生物组和不断变化的微生物病因学。

IF 2.3 3区医学

Seminars in respiratory and critical care medicine Pub Date : 2024-12-01 Epub Date: 2024-11-13 DOI: 10.1055/s-0044-1792111

Francois Fadell, Ranime Saliba, Ali A El-Solh

{"title":"Bacteriology of Aspiration Pneumonia: The Lung Microbiome and the Changing Microbial Etiology.","authors":"Francois Fadell, Ranime Saliba, Ali A El-Solh","doi":"10.1055/s-0044-1792111","DOIUrl":"10.1055/s-0044-1792111","url":null,"abstract":"Aspiration pneumonia refers to the process of alveolar inflammation induced by the inhalation of oropharyngeal secretions into the lower respiratory tract. Predisposing factors comprise swallowing dysfunction, impaired cough reflex, and degenerative neurological diseases. Accumulating evidence projects a fading contribution of anaerobic bacteria in aspiration pneumonia at the expense of Gram-negative bacilli, with Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa, becoming the predominant organisms recovered from respiratory specimens. Aspiration of oropharyngeal secretions colonized with respiratory pathogens induces a profound disequilibrium of the lung microbiota resulting in a state of dysbiosis. Understanding this complex temporal variability between microbiome-host associations was only made possible with the introduction of metagenomic sequencing. In this narrative review, we summarize existing knowledge and elaborate on the evolving microbiology of aspiration pneumonia including the link between oral microbiome and pulmonary aspiration. We also highlight the progress and challenges in instituting microbiome-targeted strategies for preventing and treating the sequelae of aspiration pneumonia.","PeriodicalId":21727,"journal":{"name":"Seminars in respiratory and critical care medicine","volume":" ","pages":"626-633"},"PeriodicalIF":2.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142625934","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Ethical Issues and the Role of Palliative Care for Patients with Aspiration Pneumonia.

IF 2.3 3区医学

Seminars in respiratory and critical care medicine Pub Date : 2024-12-01 Epub Date: 2024-11-29 DOI: 10.1055/s-0044-1792110

Amanda Rosen, Bradley Hayward

引用次数: 0

Aspiration after Anesthesia: Chemical versus Bacterial, Differential Diagnosis, Management, and Prevention.

IF 2.3 3区医学

Seminars in respiratory and critical care medicine Pub Date : 2024-12-01 Epub Date: 2024-11-29 DOI: 10.1055/a-2458-4450

Denise Battaglini, Silvia De Rosa

{"title":"Aspiration after Anesthesia: Chemical versus Bacterial, Differential Diagnosis, Management, and Prevention.","authors":"Denise Battaglini, Silvia De Rosa","doi":"10.1055/a-2458-4450","DOIUrl":"https://doi.org/10.1055/a-2458-4450","url":null,"abstract":"Aspiration following anesthesia is a major patient issue and a difficulty for anesthesiologists. Aspiration syndromes are more common than anticipated, and the condition is frequently undetected. Clinical signs are often dictated by the characteristics of aspiration, such as the infectivity of the material, its volume, and the severity of the underlying clinical condition. Pulmonary aspiration can cause an acute or persistent inflammatory response in the lungs and upper airways that can be complicated by tracheobronchitis, aspiration pneumonia, aspiration pneumonitis, acute respiratory distress syndrome, and subsequent bacterial infection due to particle, acid, and bacteria-related processes. Aspiration during anesthesia, while relatively rare, poses significant risks for patient morbidity and mortality. Chemical and bacterial aspiration provide distinct diagnostic and management issues. Preventive strategies such as a complete preoperative risk assessment, adherence to fasting rules, proper patient positioning, and the use of protective airway devices are critical in reducing aspiration risk. In addition, drugs such as proton pump inhibitors can help lower stomach acidity and volume. Innovations in monitoring techniques, better training, and awareness activities are critical to enhancing aspiration event management. Given the importance of this entity, this narrative review sought to make an updated overview of the management of aspiration after anesthesia: chemical versus bacterial, differential diagnosis, management, and prevention.","PeriodicalId":21727,"journal":{"name":"Seminars in respiratory and critical care medicine","volume":"45 6","pages":"659-668"},"PeriodicalIF":2.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142755512","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Aspiration after Critical Illness: Role of Endotracheal Tube, Tracheostomy, and Swallowing Disorders. 危重病后的吸入：气管插管、气管造口术、吞咽障碍的作用。

IF 2.3 3区医学

Seminars in respiratory and critical care medicine Pub Date : 2024-12-01 Epub Date: 2024-10-21 DOI: 10.1055/a-2445-9054

Benedict Osorio, Rebecca Krakora, Geraldine Epping, Drew Wright, Kapil Rajwani

{"title":"Aspiration after Critical Illness: Role of Endotracheal Tube, Tracheostomy, and Swallowing Disorders.","authors":"Benedict Osorio, Rebecca Krakora, Geraldine Epping, Drew Wright, Kapil Rajwani","doi":"10.1055/a-2445-9054","DOIUrl":"10.1055/a-2445-9054","url":null,"abstract":"Swallowing is a complex process that involves over 50 muscles and nerves and has two critical roles: passing food from the oral cavity through the pharynx and into the esophagus and preventing contents from entering the airway. If a patient's swallowing physiology or airway protective mechanisms are disturbed, the airways and the lungs have innate defense systems to protect against injury and infection. However, critically ill patients are more likely to develop dysphagia, which is an impairment or malfunction in any aspect of the swallowing mechanism, due to the numerous interventions they undergo. When airway reflexes fail, commonly in the presence of dysphagia, aspiration can occur, which is the entry of a fluid or solid below the level of the true vocal cords. If left unmanaged, dysphagia has been associated with aspiration pneumonia, pneumonitis, airway obstruction, delayed enteral nutrition, prolonged length of intensive care unit (ICU) and hospital stay, reduced quality of life, and even death; in some cases, dysphagia is an independent risk factor for mortality. It is important to routinely assess dysphagia in all critically ill patients using a multimodal approach, including systematic assessments, scoring indices, trained specialists, and ICU nurses. Several interventions are crucial for preventing and managing dysphagia and its associated problems. Further research is necessary to help determine the best ways to prevent and manage pulmonary aspiration in critically ill patients. Several interventions are essential in preventing and managing dysphagia and the sequelae of swallowing dysfunction. Further research is needed to help elucidate the best way to avoid and manage pulmonary aspiration in critically ill patients.","PeriodicalId":21727,"journal":{"name":"Seminars in respiratory and critical care medicine","volume":" ","pages":"669-677"},"PeriodicalIF":2.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142474228","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Epidemiology and Pathogenesis of Aspiration Pneumonia.

IF 2.3 3区医学

Seminars in respiratory and critical care medicine Pub Date : 2024-12-01 Epub Date: 2024-11-29 DOI: 10.1055/s-0044-1793907

Jordi Almirall, Ramon Boixeda, Mari C de la Torre, Antoni Torres

{"title":"Epidemiology and Pathogenesis of Aspiration Pneumonia.","authors":"Jordi Almirall, Ramon Boixeda, Mari C de la Torre, Antoni Torres","doi":"10.1055/s-0044-1793907","DOIUrl":"https://doi.org/10.1055/s-0044-1793907","url":null,"abstract":"Aspiration pneumonia (AP) remains a critical health issue, especially among older and hospitalized patients. This review focuses on understanding the epidemiology and pathogenesis of AP, exploring key risk factors, and proposing diagnostic strategies. Aspiration pneumonia is commonly associated with hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP), where pathogens introduced into the lungs from gastric aspiration cause infection. Several factors, such as oropharyngeal dysphagia, silent aspiration, and poor oral health, contribute to increased risk, especially in frail elderly populations with chronic comorbidities. Diagnostic criteria for AP are not well-defined, complicating accurate diagnosis. Radiographic evidence of pulmonary infiltrates, history of aspiration, and clinical symptoms, such as cough and fever, guide diagnosis, but the absence of specific biomarkers remains a challenge. Furthermore, the microbiome of the lung, which shares characteristics with the oropharyngeal flora, plays a pivotal role in the development of infection. The incidence of AP is likely to increase given the growing elderly population with factors predisposing them to aspiration. It is one of the most common types of pneumonia in older adults, with its prevalence estimated to range from 5% to 24% in cases of CAP admissions. This revision highlights the growing need for comprehensive diagnostic tools and treatment protocols for AP, especially in high-risk populations such as the elderly and those in long-term care. Understanding the underlying mechanisms and the role of silent aspiration can improve prevention strategies and reduce morbidity and mortality in these vulnerable groups.","PeriodicalId":21727,"journal":{"name":"Seminars in respiratory and critical care medicine","volume":"45 6","pages":"621-625"},"PeriodicalIF":2.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142755519","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0