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[Dysphagia] Re: how much water?
Below are some other diagnostic criteria for aspiration pneumonia used in
studies in the literature - lots of differences, but, also, used on
different populations - ie. Giselle Mann's study was acute stroke, Susan
Langmore's was male veterans.
Diagnostic Criteria
Respiratory difficulty, moist rales on auscultation plus 2 of the
following: (Johnson 1993)
1.. Temperature above 100 ?F
2.. White blood cell count > 10,000
3.. Evidence of hypoxia
Three or more of the following signs: (De Pippo, 1994)
1.. Sustained febrile illness > 100 oF
2.. Presence of rales or rhonchi on chest auscultation
3.. Drop in arterial PO2 > 10 Torr compared with baseline values
4.. Sputum Gram's stain showing significant number of leucocytes
5.. Sputum culture showing respiratory pathogens
Three or more of the following signs: (Ding and Logemann 2000)
1.. Fever
2.. Positive ausculatory findings on chest examination
3.. Productive cough
4.. PaO2 below 70mmHg or a 10mmHg decrease from the patient's
baseline
5.. Purulent sputum
6.. Gram stain or pathogen isolated from sputum culture
7.. Positive chest x-ray.
All three criteria must be present: (Langmore 1998)
1.. Elevated white blood cell count (12,000 or above)
2.. Fever: temperature above 100.5 oF
3.. New infiltrate on chest x-ray.
Respiratory crackles with one of the following: (Evans, 2001)
1.. Purulent sputum,
2.. Pyrexia,
3.. Leucocytosis
4.. Positive chest radiograph
1.. Positive blood or pleural cultures for the same microorganism
identified in the tracheal aspirate (Moore, 2002)
2.. New or progressive pulmonary infiltrate
3.. Fever (> 38? C)
4.. Leucocytosis (> 10,000/mm3 )
5.. Gram stained sputum samples with > 10 polymorphonuclear cells
per high power field and
6.. No other source of infection but the lungs
----- Original Message -----
From: "Jai Gupta" <GuptaJ@SESAHS.NSW.GOV.AU>
To: "Irene Campbell-Taylor" <eripley@yahoo.com>; <Dysphagia@b9.com>
Sent: Tuesday, March 15, 2005 10:09 AM
Subject: RE: [Dysphagia] Re: how much water?
Hi, I am aware of that literature referred to, so am I aware of literature
on hydration. Fundamental question is how much one should drink and in
reality what is happening? I am not aware if this simple research question?
.... I am just illustrating what is happening in real world ...these are
interview and observation from real world .... and I disagree...any of them
were diagnosed as dehydrated ...they live like that of years ...another
interesting case ..I have met a lady who was 92 yrs and never had water as
far as her memory could go ..she hated the taste of water ....loved light
tea (I know Tea is DIURETIC :-), she is still living and dehydration has
never been an issue with her.... it does not support the research something
is wrong some were?
About diagnosis ...This will help those who seek simple solution to Asp
Pneu... ..as SLP we have to aware of complexities..... and this info helps
me esp with stroke clients .. Identification of Aspiration Pneumonia*
Diagnosis based on three or more of the following variables
? Fever (> 38? C)
? Productive cough with purulent sputum
? Abnormal respiratory examination (tachypnoea > 22 breaths/min,
tachycardia, inspiratory crackles, bronchial breathing)
? Abnormal chest radiograph
? Arterial hypoxaemia (PO2<9.3 kPa)
? Isolation of a relevant pathogen (positive Gram stain or culture)
*Ref: Mann G, Dip PG, Hankey GJ, et al. Swallowing function after stroke.
Stroke 1999;30:744-8
Jai Gupta. M.Sc.(S.H.) CPSP MSPA
Manager, Speech Pathology Services.
The Sutherland Hospital
* Locked Bag 21, Taren Point NSW 2229
* 9540 7111 page 594 or Direct 9540 7558
* 9540 7717 *0401 373 324
email: guptaJ@sesahs.nsw.gov.au
Weblink: ozspeech
Webmaster: Evidence Based Practice in Speech Pathology
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