Gastrointestinal Physiology Laboratory, CIBERehd CSdM-UAB, Department of Surgery, Hospital de Mataró, Universitat Autónoma de Barcelona, Barcelona, Catalunya, Spain.
Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Comunidad de Madrid, Spain.
Semin Respir Crit Care Med. 2024 Dec;45(6):678-693. doi: 10.1055/a-2445-8952. Epub 2024 Oct 21.
Aspiration pneumonia (AP) is the most severe complication of oropharyngeal dysphagia (OD). It is highly underdiagnosed and undertreated among older patients hospitalized with community-acquired pneumonia (CAP). Our aim is to review the state of the art in the diagnosis and treatment of swallowing disorders associated with AP. We performed a narrative review, including our experience with prior studies at Hospital de Mataró, on the diagnosis and treatment of AP. AP refers to pneumonia occurring in patients with swallowing disorders, frequently coinciding with poor oral health and vulnerability. Its main risk factors include oropharyngeal aspiration, impaired health status, malnutrition, frailty, immune dysfunction, and oral colonization by respiratory pathogens. Incidence is estimated at between 5 and 15% of cases of CAP, but it is highly underdiagnosed. Diagnostic criteria for AP have not been standardized but should include its main pathophysiological element, oropharyngeal aspiration. Recently, a clinical algorithm was proposed, based on the recommendations of the Japanese Respiratory Society, that includes aspiration risk factors and clinical evaluation of OD. To facilitate the task for health care professionals, new artificial intelligence (AI)-based screening tools for OD combined with validated clinical methods such as the volume-viscosity swallowing test (V-VST) for the detection of AP are being validated. Prevention and treatment of AP require multimodal interventions aimed to cover the main risk factors: textural adaptation of fluids and diets to avoid oropharyngeal aspiration; nutritional support to avoid malnutrition; and oral hygiene to reduce oral bacterial load. The diagnosis of AP must be based on standardized criteria providing evidence on the main etiological factor, oropharyngeal aspiration. Clinical algorithms are valid in the diagnosis of AP and the identification of its main risk factors. Combination of AI-based tools with V-VST can lead to massive screening of OD and save resources and improve efficiency in the detection of AP.
吸入性肺炎（AP）是口咽性吞咽障碍（OD）最严重的并发症。在因社区获得性肺炎（CAP）住院的老年患者中，AP 诊断率低，治疗不足。我们旨在回顾与 AP 相关的吞咽障碍的诊断和治疗的最新进展。我们进行了叙述性综述，包括我们在 Hospital de Mataró 进行的先前研究经验，以探讨 AP 的诊断和治疗。AP 是指吞咽障碍患者发生的肺炎，常伴有口腔卫生不良和易感性。其主要危险因素包括口咽吸入、健康状况受损、营养不良、虚弱、免疫功能障碍和呼吸道病原体的口腔定植。CAP 病例的发病率估计在 5%至 15%之间，但诊断率很低。AP 的诊断标准尚未标准化，但应包括其主要的病理生理要素，即口咽吸入。最近，根据日本呼吸学会的建议提出了一种临床算法，其中包括吸入危险因素和 OD 的临床评估。为了方便医疗保健专业人员的任务，正在验证新的基于人工智能（AI）的 OD 筛查工具以及验证的临床方法（如体积粘度吞咽测试（V-VST）），以检测 AP。AP 的预防和治疗需要多模式干预，旨在涵盖主要的危险因素：调整液体和饮食的质地以避免口咽吸入；营养支持以避免营养不良；口腔卫生以减少口腔细菌负荷。AP 的诊断必须基于提供主要病因因素（口咽吸入）的证据的标准化标准。临床算法在 AP 的诊断和主要危险因素的识别中是有效的。AI 工具与 V-VST 的结合可以实现 OD 的大规模筛查，节省资源并提高 AP 检测的效率。
