The Safety and Effectiveness of Pharmacotherapy for Opioid-Overdose Induced Aspiration Pneumonia in a Referral Poisoning Management University Hospital in Iran

Tabatabaei, Mohammadreza; Dorvashy, Gholamali; Soltani, Rasoul; Samsamshariat, Shiva; Meamar, Rokhsareh; Sabzghabaee, Ali Mohammad

doi:10.4103/jrpp.jrpp_21_17

Cited by 3 publications

(1 citation statement)

References 12 publications

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“…In addition to well-known respiratory-depressant effects, opioids also depress the immune system, gastrointestinal system, and airway defense mechanisms (e.g., cough) [23,29,30]. Clinical trials have reported esophageal dysfunction and aspiration in humans following opioid administration, and several reports have identified aspiration pneumonia as a serious complication of opioid use following both overdose and chronic use [31][32][33][34][35][36][37]. While it is likely that aerodigestive dysregulation is a contributing factor to aspiration pneumonia following opioid use, specific effects of opioids on pharyngeal swallow have been the subject of limited investigation.…”

Section: Introductionmentioning

confidence: 99%

Serotonin therapies for opioid-induced dysphagia and respiratory depression: sex differences in a rat electromyography model

Frazure,

Morimoto,

Fielder

et al. 2023

Preprint

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Opioids are well-known to cause respiratory depression, but despite clinical evidence of dysphagia, the effects of opioids on swallow excitability and motor pattern are unknown. We sought to test the effects of the clinically-relevant opioid buprenorphine on pharyngeal swallow and respiratory drive in male and female rats. We also evaluated utility of serotonin 5-HT1A agonists (8-OH-DPAT and buspirone) to improve swallowing and breathing outcomes following buprenorphine administration. Experiments were performed on 44 freely breathing Sprague Dawley rats anesthetized with sodium pentobarbital. Bipolar fine wire electrodes were inserted into the mylohyoid, thyroarytenoid, posterior cricoarytenoid, thyropharyngeus and diaphragm muscles to measure electromyographic (EMG) activity of swallowing and breathing behaviors. We evaluated the hypotheses that swallow varies by stimulus, opioids depress swallow and breathing, and that 5-HT1A agonists improve these depressions. Our results largely confirmed the hypotheses: 1) Swallow-related muscle activity was larger during swallows elicited by oral water infusion plus esophageal distension than by either stimulus alone. 2) Buprenorphine depressed swallow in both sexes, but most significantly in females. 3) Female animals were more susceptible to buprenorphine-induced respiratory arrest. 4) 8-OH-DPAT rescued breathing following buprenorphine-induced respiratory arrest, and pre-treatment with the partial 5-HT1A agonist buspirone prevented buprenorphine-induced respiratory arrest in female animals. 5) 8-OH-DPAT enhanced swallow-related mylohyoid drive, but did not restore excitability of the swallow pattern generator following total suppression by buprenorphine. Our results highlight sex-specific and behavior-specific effects of buprenorphine and provide pre-clinical evidence of a 5HT1A agonist for the treatment of respiratory depression and dysphagia.

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Section: Introductionmentioning

confidence: 99%

Serotonin therapies for opioid-induced dysphagia and respiratory depression: sex differences in a rat electromyography model

Frazure,

Morimoto,

Fielder

et al. 2023

Preprint

View full text Add to dashboard Cite

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Serotonin therapies for opioid-induced disordered swallow and respiratory depression

Frazure,

Morimoto,

Fielder

et al. 2024

Journal of Applied Physiology

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Opioids are well-known to cause respiratory depression, but despite clinical evidence of dysphagia, effects of opioids on swallow excitability and motor pattern are unknown. We tested the effects of the clinically-relevant opioid buprenorphine on pharyngeal swallow and respiratory drive in male and female rats. We also evaluated the utility of 5-HT1A agonists (8-OH-DPAT and buspirone) to improve swallowing and breathing following buprenorphine administration. Experiments were performed on 44 freely breathing Sprague Dawley rats anesthetized with sodium pentobarbital. Bipolar fine wire electrodes were inserted into the mylohyoid, thyroarytenoid, posterior cricoarytenoid, thyropharyngeus and diaphragm muscles to measure electromyographic (EMG) activity of swallowing and breathing. We evaluated the hypotheses that swallow varies by stimulus, opioids depress swallow and breathing, and that 5-HT1A agonists improve these depressions. Our results largely confirmed the hypotheses: 1) Swallow-related EMG activity was larger during swallows elicited by esophageal distension plus oral water infusion than by either stimulus alone. 2) Buprenorphine depressed swallow in both sexes, but females were more susceptible to total swallow suppression. 3) Female animals were also more vulnerable to opioid-induced respiratory depression. 4) 8-OH-DPAT rescued breathing following buprenorphine-induced respiratory arrest, and pre-treatment with the partial 5-HT1A agonist buspirone prevented buprenorphine-induced respiratory arrest in female animals. 5) 8-OH-DPAT enhanced mylohyoid and thyropharyngeus EMG amplitude during swallow but did not restore excitability of the swallow pattern generator following total suppression by buprenorphine. Our results highlight sex-specific and behavior-specific effects of buprenorphine and provide pre-clinical evidence of a 5HT1A agonist for the treatment of respiratory depression and dysphagia.

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Antibiotics versus Non-Antibiotic in the treatment of Aspiration Pneumonia: analysis of the MIMIC-IV database

Zhang,

Yang,

et al. 2024

BMC Pulm Med

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Background Aspiration pneumonia (AP) is a common complication in the intensive care unit (ICU), which is associated with significantly increased morbidity and mortality and has a significant impact on patient prognosis. Antibiotics are commonly used in the clinical treatment of AP. However, the prognostic impact of antibiotics on patients with AP has not been adequately characterized. The purpose of this study is to illustrate the relationship between the use of antibiotics and in-hospital mortality of AP patients, as well as to analyze the effects of different antibiotic treatment regimens on the prognosis of the patients, and to further understand the distribution of pathogens and drug resistance in AP patients, so as to provide guidance information for the rational use of medication for patients in the clinic. Methods Clinical data of AP patients were extracted from the MIMIC-IV database. Statistical methods included multivariate logistic regression, propensity score matching (PSM), and inverse probability weighting (IPW) based on propensity scores to ensure the robustness of the findings. In addition, the characteristics of the medications used by patients with AP were described using statistical graphs and tables. Results A total of 4132 patients with AP were included. In-hospital mortality was significantly lower in the group using antibiotics compared to the group not using antibiotics (odds ratio [OR] = 0.44, 95% confidence interval [CI] 0.27- 0.71, P = 0.001). Furthermore, in the group using mechanical ventilation (MV), antibiotics use significantly reduced in-hospital mortality (OR = 0.30, 95% CI 0.15–0.57, P < 0.001). Vancomycin and cephalosporins are the most commonly used antibiotics to treat AP. Specifically, vancomycin in combination with piperacillin-tazobactam was used most frequently with 396 cases. The highest survival rate (97.6\%) was observed in patients treated with levofloxacin combined with metronidazole. Additionally, vancomycin combined with piperacillin-tazobactam had many inflammation related features that differed significantly from those in patients who did not receive medication. Conclusions Antibiotics use is closely associated with lower in-hospital mortality in ICU patients with AP. Moreover, understanding antibiotics use, the composition of pathogenic bacteria, and the rates of drug resistance in patients with AP can aid in disease prevention and prompt infection control. Supplementary Information The online version contains supplementary material available at 10.1186/s12890-024-03441-8.

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The Safety and Effectiveness of Pharmacotherapy for Opioid-Overdose Induced Aspiration Pneumonia in a Referral Poisoning Management University Hospital in Iran

Cited by 3 publications

References 12 publications

Serotonin therapies for opioid-induced dysphagia and respiratory depression: sex differences in a rat electromyography model

Serotonin therapies for opioid-induced dysphagia and respiratory depression: sex differences in a rat electromyography model

Serotonin therapies for opioid-induced disordered swallow and respiratory depression

Antibiotics versus Non-Antibiotic in the treatment of Aspiration Pneumonia: analysis of the MIMIC-IV database

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