Longitudinal CT evaluation of transdermal scopolamine for aspiration pneumonia with sialorrhea in severe chronic brain injury: A case series

Abstract

Sialorrhea is a major cause of recurrent aspiration pneumonia in severe chronic brain injury. Previous reports have shown that transdermal scopolamine can decrease saliva production. We present four patients with severe chronic brain injury who experienced repeat aspiration pneumonia with sialorrhea. Longitudinal computed tomography examinations to assess the therapeutic effect were performed in all four cases before and after transdermal scopolamine. Transdermal scopolamine was applied as a patch (0.1 g/2.5 cm2) behind the earlobe every 24 h after confirming the absence of glaucoma. Patches were formulated as an in-hospital preparation (scopolamine butylbromide 0.25 g and hydrophilic cream 4.75 g) under the approval of our institutional review board. Longitudinal computed tomography after transdermal scopolamine use showed a decrease in pleural effusions associated with continuous aspiration pneumonia in all four cases. The data from repeat computed tomography suggest that long-term transdermal scopolamine for reducing saliva production may be a reasonable option for appropriate palliative care in severe chronic brain injury patients.

The effectiveness of ultrasound‐guided injection of BTX‐A in the management of sialorrhea in neurogenic dysphagia patients

“…If the MSS score was two or higher, there would be a 13.6 times higher chance of aspiration than those patients with lower scores 27 . Chronic saliva aspiration eventually leads to pneumonia or even death 8,24,28,29 . After BTX injection, recruited patients in this study tend to have a lower MSS score than before the injection.…”

“…27 Chronic saliva aspiration eventually leads to pneumonia or even death. 8,24,28,29 After BTX injection, recruited patients in this study tend to have a lower MSS score than before the injection. There were 78% (25 out 32) patients' MSS score decreased from 3 after 2 weeks injection.…”

O uso da escopolamina para o controle da hipersecreção em pacientes em cuidados paliativos

“…Divididos em grupo controle e grupo placebo, os pacientes que receberam cerca de 20mg de escopolamina administradas via subcutânea todos os dias até o processo ativo de morte, tiveram redução do ruído ou simplesmente não apresentaram sororoca, quando comparados ao grupo placebo (Van Esch et al, 2021). Yamaki et al (2022) trouxeram em seu estudo uma série de casos em que foi utilizado tomografia computadorizada (TC) para comprovar o efeito da escopolamina, que foi utilizada via transdérmica através de um adesivo de 0.1g/2.5cm2 alocado no lóbulo da orelha dos pacientes. Nos quatro casos descritos, os pacientes apresentavam derrame pleural associado a pneumonia aspirativa por conta hipersecreção desenvolvida ao longo da internação, pois em estado mínimo de consciência a sialorreia pode provocar asfixia, broncoaspiração, babação entre outros, aumentando o risco de vida.…”