Factors associated with aspiration pneumonia and preventive measures in hospitalized elderly: a systematic review of observational studies

Santos, Daniela de Arimateia Rosa; Arcanjo, Débora de Paula Silva; Silva, Geiza Maria Bezerra de Melo e; Mendes, Amanda Louize Félix; Mendonça, Simonize Cunha Barreto de; Lima, Thales Rafael Correia de Melo; Taguchi, Carlos Kazuo; Araújo, Brenda Carla Lima

doi:10.1590/1982-0216/20202262920

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REVIEW ARTICLES • Rev. CEFAC 22 (6) • 2020 • https://doi.org/10.1590/1982-0216/20202262920 copy

Factors associated with aspiration pneumonia and preventive measures in hospitalized elderly: a systematic review of observational studies

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Purpose:

to identify associated factors and preventive measures for aspiration pneumonia in hospitalized elderly patients.

Methods:

the PPOT (population, predictor, outcome, and type of study) was the strategy used to define the eligibility criteria: (1) Population: people over 60 years of age; (2) predictor: hospitalized patients (3) Outcomes: associated factors and measures to prevent aspiration pneumonia; (4) Type of study: Observational Studies (transversal and case-control). We performed the data collection in the PubMed, Lilacs, Scielo, Google Scholar, Science Direct, and Web of Science databases. Observational studies on factors associated with aspiration pneumonia and preventive measures in the elderly, without language restriction and available in full, were included. Data on authors/year/country, objective, methodology, sample, and results, were collected. The risk of bias was assessed, according to the JBI Critical Appraisal Checklist.

Results:

a case-control and two cross-sectional studies were analyzed. One paper presented a smaller sample with 86 patients, and another presented a larger sample comprising 443 patients. The median age was 77 years old.

Conclusion:

factors such as severe stroke, dysphagia, advanced age, male gender, coronary heart disease, lower Glasgow coma scale score, use of mechanical ventilation for more than 48 hours, and aspiration of colonized gastric juice were associated with aspiration pneumonia.

Keywords:
Speech, Language and Hearing Sciences; Aged; Aspiration Pneumonia; Deglutition Disorders; Systematic Review

Search Strategy	Definition	Description
P	Population	People over 60 years of age, regardless of age and gender.
P	Predictor	People who were hospitalized.
O	Outcomes	Risk and/or measures to prevent aspiration pneumonia, liquid substances, secretion and gastroesophageal reflux.
T	Study type	Observational Studies, including cross-sectional, case control and accuracy studies.

Databases	Search strategy (November 2018)	No.
PubMed	(((“Aspiration Pneumonias”) OR (“Pneumonias, Aspiration”) OR (“Aspiration Pneumonia”) OR (“Pneumonia, Aspiration”[Mesh])) AND ((“Factor, Risk”) OR (“Factors, Risk”) OR (“Risk Factor”) OR (“Risk Factors” [Mesh])) AND ((“prophylaxis”) OR (“preventive therapy”) OR (“prevention and control”) OR (“preventive measures”) OR (“prevention”) OR (“control”) OR (“prevention and control [Subheading]” [Mesh])))	418
Web OF Science	(((Aspiration Pneumonias) OR (Pneumonias, Aspiration) OR (Aspiration Pneumonia) OR (Pneumonia, Aspiration)) AND ((Factor, Risk) OR (Factors, Risk) OR (Risk Factor) OR (Risk Factors)) AND ((prophylaxis) OR (preventive therapy) OR (prevention and control) OR (preventive measures) OR (prevention) OR (control) OR (prevention and control)))	368
Science Direct	(((“Aspiration Pneumonias”) OR (“Pneumonias, Aspiration”) OR (“Aspiration Pneumonia”) OR (“Pneumonia, Aspiration”) AND ((“Factor, Risk”) OR (“Factors, Risk”) OR (“Risk Factor”) OR (“Risk Factors”)) AND ((“prophylaxis”) OR (“preventive therapy”) OR (“prevention and control”) OR (“preventive measures”) OR (“prevention”) OR (“control”) OR (“prevention and control”)))	436
LiLacs	(((Aspiration Pneumonias) OR (Pneumonias, Aspiration) OR (Aspiration Pneumonia) OR (Pneumonia, Aspiration)) AND ((Factor, Risk) OR (Factors, Risk) OR (Risk Factor) OR (Risk Factors)) AND ((prophylaxis) OR (preventive therapy) OR (prevention and control) OR (preventive measures) OR (prevention) OR (control) OR (prevention and control)))	12
Scielo	(((Aspiration Pneumonias) OR (Pneumonias, Aspiration) OR (Aspiration Pneumonia) OR (Pneumonia, Aspiration)) AND ((Factor, Risk) OR (Factors, Risk) OR (Risk Factor) OR (Risk Factors)) AND ((prophylaxis) OR (preventive therapy) OR (prevention and control) OR (preventive measures) OR (prevention) OR (control) OR (prevention and control)))	03
Google Scholar	“Aspiration Pneumonias” OR “Pneumonias, Aspiration” OR “Aspiration Pneumonia” OR “Pneumonia, Aspiration”AND “Factor, Risk” OR “Factors, Risk” OR “Risk Factor” OR “Risk Factors” AND “prophylaxis” OR “preventive therapy” OR “prevention and control” OR “preventive measures” OR “prevention” OR “control” OR “prevention and control ”	100
Summation ∑		1337

Authors / Year / Country	Objective	Metodology	Type of study	Sample (n)	Age	Results
Ishigami et al.¹² 2012 Japan	To assess the association of elevated blood pressure in the acute phase with the incidence of pneumonia.	Three groups of patients were compared: 10 elderly patients with acute ischemic stroke with severe hypertension, 43 patients with moderate hypertension and 65 normotensive or slightly hypertensive controls. Data were collected on known risk factors, type of IVCA and underlying chronic conditions.	Case-Control	58♂ and 60♀	72-96 years	AP in patients with acute ischemic stroke was higher in the moderately hypertensive group, along with lower GCS score, dysphagia, male gender and coronary heart disease.
Masrur et al.¹³ 2013 United States	To examine: the incidence and results of dysphagia screening along with the factors associated with its occurrence; the incidence and results in patients with APand the risk factors associated with their occurrence; the relationship between DSand APin patients with IVCA.	Consecutive hospitalizations for stroke were identified through retrospective identification using the International Classification of Diseases and the Ninth Revision of discharge codes, surveillance of emergency records, ward records or neurological consultations.	cross-sectional	212♂ and 231♀	61-82 years	Of the eligible patients, 5.7% (17,906) developed AP. When compared to patients without AP, patients with BP were older, had an increase in hospital stay and mortality.
Liu et al.¹⁴ 2015 China	To verify the gastropulmonary route of infection in the pathogenesis of PA in ventilated patients, and to develop a diagnostic tool for microaspiration; Investigate the prevalence of microaspiration in order to develop effective prevention strategies.	Were used field gel electrophoresis with macrorestrictionby pulse to verify the infection pathway and to investigate the prevalence of microaspiration in ventilated elderly patients expected to receive mechanical ventilation over 48 h, enrolled from October 2009 to January 2012.	cross-sectional	53♂ and 33♀	60-92 years	Almost 30% of the MVAP were caused by microaspiration. About 58.3% of patients with gastric colonization developed VAP.

Authors and Year	Q1	Q2	Q3	Q4	Q5	Q6	Q7	Q8			% Yes / Risk	Risk of Bias
Masrur et al.	--	√	--	√	√	√	--	√			62.5	++ Moderate
Liu et al.	√	√	√	√	√	--	√	√			87.5	+ Low
Authors and Year	Q1	Q2	Q3	Q4	Q5	Q6	Q7	Q8	Q9	Q10	% Yes / Risk	Risk of Bias
Ishigami et al.	√	√	√	I	√	√	√	√	√	√	87.5	+ Low

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[1] Corresponding address: Daniela de Arimateia Rosa Santos, Rua A, Loteamento Mangueira, 277 - Bairro: Dezoito do Forte, CEP: 49072-629 - Aracaju, Sergipe, Brasil, E-mail: fgadanielarimateia@gmail.com