For airway clearance, comorbidities that compromise clearance include tracheobronchomalacia, airway compression/stenosis/hypoplasia, restrictive lung disease (neuromuscular, chest wall deformities, scoliosis), and vocal cord or diaphragmatic dysfunction/paralysis from esophageal or cardiac surgery.
Aerodigestive Management of Pediatric Aspiration - FULL SHOW
▶Ep 7 · 0:16
clinicalAspiration is defined as any solid or liquid matter passing below the vocal cords, though some define it as requiring pulmonary compromise in addition to passage below the cords.↗
▶Ep 7 · 0:16
host_summaryAspiration is defined as any solid or liquid matter passing below the vocal cords, though some define it as requiring pulmonary compromise in addition to passage below the cords.↗
▶Ep 7 · 0:39
host_summaryAspiration can be silent with no clinical indication, or obvious with coughing, choking, and sputtering.↗
▶Ep 7 · 0:39
clinicalAspiration can be silent with no clinical indication, or obvious with coughing, choking, and sputtering.↗
▶Ep 7 · 1:51
epidemiologicalChildren with CHARGE syndrome have 80 to 90% prevalence of aspiration at some point in their lifetime and should be assumed to aspirate until proven otherwise.↗
▶Ep 7 · 1:51
host_summaryChildren with CHARGE syndrome have 80 to 90% prevalence of aspiration at some point in their lifetime and should be assumed to aspirate until proven otherwise.↗
▶Ep 7 · 2:01
host_summaryChildren with severe neurologic compromise regardless of etiology should be assumed to aspirate until demonstrated otherwise.↗
▶Ep 7 · 2:01
clinicalChildren with severe neurologic compromise regardless of etiology should be assumed to aspirate until demonstrated otherwise.↗
▶Ep 7 · 2:32
clinicalThe clinical significance of aspiration depends on the quantity—small isolated events are usually cleared by host defenses (cough, mucociliary transport), while large or repeated events overcome host defenses.↗
▶Ep 7 · 2:32
host_summaryThe clinical significance of aspiration depends on the quantity—small isolated events are usually cleared by host defenses (cough, mucociliary transport), while large or repeated events overcome host defenses.↗
▶Ep 7 · 3:06
host_summaryA single aspiration event of caustic substance can have lifelong consequences.↗
▶Ep 7 · 3:06
clinicalA single aspiration event of caustic substance can have lifelong consequences.↗
▶Ep 7 · 3:31
clinicalChronic pulmonary aspiration is defined as repeated aspiration into the lower airways causing pulmonary injury or chronic respiratory disease, with consequences determined by frequency, magnitude, nature of material, and effectiveness of host defenses.↗
▶Ep 7 · 3:31
clinicalChronic pulmonary aspiration is defined as repeated aspiration into the lower airways causing pulmonary injury or chronic respiratory disease, with consequences determined by frequency, magnitude, nature of material, and effectiveness of host defenses.↗
▶Ep 7 · 4:34
clinicalFour major groups aspirate: premature babies, those with neurologic disabilities, those with airway disease (anatomic, dynamic, or functional), and those with gastrointestinal disorders.↗
▶Ep 7 · 4:34
clinicalFour major groups aspirate: premature babies, those with neurologic disabilities, those with airway disease (anatomic, dynamic, or functional), and those with gastrointestinal disorders.↗
▶Ep 7 · 5:02
clinicalSyndromes with significant swallowing dysfunction include CHARGE, Cri-du-chat, Möbius syndrome (cranial nerve abnormalities), and craniofacial defects like Pfeiffer, Crouzon, and Treacher Collins.↗
▶Ep 7 · 5:02
host_summarySyndromes with significant swallowing dysfunction include CHARGE, Cri-du-chat, Möbius syndrome (cranial nerve abnormalities), and craniofacial defects like Pfeiffer, Crouzon, and Treacher Collins.↗
▶Ep 7 · 44:25
host_summaryLipid-laden macrophages are the most commonly used aspiration biomarker, with a lipid-laden macrophage index >90 or >20% of macrophages containing lipid suggesting aspiration.↗
▶Ep 7 · 44:25
clinicalLipid-laden macrophages are the most commonly used aspiration biomarker, with a lipid-laden macrophage index >90 or >20% of macrophages containing lipid suggesting aspiration.↗
▶Ep 7 · 45:56
clinicalElevated lipid-laden macrophages are not pathognomonic of aspiration—they can result from natural airway debris (dead neutrophils, macrophages from inflammation) or circulation after bleeding or airway surgery.↗
▶Ep 7 · 45:56
clinicalElevated lipid-laden macrophages are not pathognomonic of aspiration—they can result from natural airway debris (dead neutrophils, macrophages from inflammation) or circulation after bleeding or airway surgery.↗
▶Ep 7 · 46:38
clinicalLipid-laden macrophages are a limited tool because aspirated material has variable lipid content (saliva has no lipid), there is variable time between aspiration and BAL sampling affecting lipid metabolism, and individuals have variable rates of lipid catabolism.↗
▶Ep 7 · 46:38
clinicalLipid-laden macrophages are a limited tool because aspirated material has variable lipid content (saliva has no lipid), there is variable time between aspiration and BAL sampling affecting lipid metabolism, and individuals have variable rates of lipid catabolism.↗
▶Ep 7 · 48:08
clinicalHaving a tracheostomy tube changes the dynamics of laryngeal elevation but most studies show it does not create aspiration.↗
▶Ep 7 · 48:08
host_summaryHaving a tracheostomy tube changes the dynamics of laryngeal elevation but most studies show it does not create aspiration.↗
▶Ep 7 · 49:10
clinicalDecanulation should not proceed until the child has proven capacity to clear their airway through a prolonged capping trial that includes going through illnesses without needing the tracheostomy for clearance.↗
▶Ep 7 · 49:10
quoteIt's not what you get in, it's how you get it out.↗
▶Ep 7 · 49:10
quoteIt's not what you get in, it's how you get it out.↗
▶Ep 7 · 49:10
clinicalDecanulation should not proceed until the child has proven capacity to clear their airway through a prolonged capping trial that includes going through illnesses without needing the tracheostomy for clearance.↗
▶Ep 7 · 49:56
clinicalSpeaking valves help with airway clearance by allowing glottic closure for better cough and creating positive end-expiratory pressure that distends airways, even if they do not decrease aspiration coming in.↗
▶Ep 7 · 49:56
clinicalSpeaking valves help with airway clearance by allowing glottic closure for better cough and creating positive end-expiratory pressure that distends airways, even if they do not decrease aspiration coming in.↗
▶Ep 7 · 51:44
opinionThe pulmonologist's role in the aerodigestive team is to protect children from developing irreversible long-term pulmonary sequelae while managing anatomic abnormalities or waiting for maturity.↗
▶Ep 7 · 51:44
opinionThe pulmonologist's role in the aerodigestive team is to protect children from developing irreversible long-term pulmonary sequelae while managing anatomic abnormalities or waiting for maturity.↗
▶Ep 7 · 58:16
clinicalMedical management of functional aspiration should target five aspects: decrease aspiration events, improve airway clearance, address quality of aspirated material, control inflammation, and treat or prevent infections.↗
▶Ep 7 · 58:16
clinicalMedical management of functional aspiration should target five aspects: decrease aspiration events, improve airway clearance, address quality of aspirated material, control inflammation, and treat or prevent infections.↗
▶Ep 7 · 1:00:11
host_summaryFor airway clearance, comorbidities that compromise clearance include tracheobronchomalacia, airway compression/stenosis/hypoplasia, restrictive lung disease (neuromuscular, chest wall deformities, scoliosis), and vocal cord or diaphragmatic dysfunction/paralysis from esophageal or cardiac surgery.↗
▶Ep 7 · 1:00:11
clinicalFor airway clearance, comorbidities that compromise clearance include tracheobronchomalacia, airway compression/stenosis/hypoplasia, restrictive lung disease (neuromuscular, chest wall deformities, scoliosis), and vocal cord or diaphragmatic dysfunction/paralysis from esophageal or cardiac surgery.↗
▶Ep 7 · 1:02:17
clinicalChronic inflammation from aspiration is managed with inhaled steroids and systemic anti-inflammatory medication (azithromycin, not systemic steroids as first-line), with systemic steroids reserved for acute aspiration events to prevent pneumonitis.↗
▶Ep 7 · 1:02:17
clinicalChronic inflammation from aspiration is managed with inhaled steroids and systemic anti-inflammatory medication (azithromycin, not systemic steroids as first-line), with systemic steroids reserved for acute aspiration events to prevent pneumonitis.↗
▶Ep 7 · 1:03:30
clinicalPatients with bronchiectasis from chronic aspiration should receive longer antibiotic courses (10-14 days instead of 7-10 days) because bronchiectatic cavities have more difficult clearance.↗
▶Ep 7 · 1:03:30
clinicalPatients with bronchiectasis from chronic aspiration should receive longer antibiotic courses (10-14 days instead of 7-10 days) because bronchiectatic cavities have more difficult clearance.↗
▶Ep 7 · 1:03:42
clinicalProphylactic inhaled antibiotics (tobramycin or colistimethate, either every other month or 14 days per month) are reserved for patients with severe bronchiectasis and pulmonary injury or significant frequency of infections.↗
▶Ep 7 · 1:03:42
clinicalProphylactic inhaled antibiotics (tobramycin or colistimethate, either every other month or 14 days per month) are reserved for patients with severe bronchiectasis and pulmonary injury or significant frequency of infections.↗
▶Ep 7 · 1:04:56
clinicalCuff tubes cannot stop aspiration because inflating the cuff enough to decrease leak causes unacceptable tracheal injury or dilation.↗
▶Ep 7 · 1:04:56
clinicalCuff tubes cannot stop aspiration because inflating the cuff enough to decrease leak causes unacceptable tracheal injury or dilation.↗
▶Ep 7 · 1:05:45
clinicalPositive pressure ventilation (CPAP or BiPAP) can decrease aspiration events, especially during sleep in patients with reflux aspiration, even in patients who do not need it for gas exchange or ventilation.↗
▶Ep 7 · 1:05:45
clinicalPositive pressure ventilation (CPAP or BiPAP) can decrease aspiration events, especially during sleep in patients with reflux aspiration, even in patients who do not need it for gas exchange or ventilation.↗
▶Ep 7 · 1:06:39
clinicalPassy-Muir valves should never be used during sleep because they allow inhalation through the tracheostomy but not exhalation, risking obstruction from mucus accumulation, and they cause over-drying of secretions leading to mucus plugging.↗
▶Ep 7 · 1:06:39
clinicalPassy-Muir valves should never be used during sleep because they allow inhalation through the tracheostomy but not exhalation, risking obstruction from mucus accumulation, and they cause over-drying of secretions leading to mucus plugging.↗
Aerodigestive Management of Pediatric Aspiration - FULL SHOW
▶Ep 2 · 0:16
host_summaryAspiration is defined as any solid or liquid matter passing below the vocal cords, though some define it as requiring pulmonary compromise in addition to passage below the cords.↗
▶Ep 2 · 0:39
host_summaryAspiration can be silent with no clinical indication, or obvious with coughing, choking, and sputtering.↗
▶Ep 2 · 1:51
host_summaryChildren with CHARGE syndrome have 80 to 90% prevalence of aspiration at some point in their lifetime and should be assumed to aspirate until proven otherwise.↗
▶Ep 2 · 2:01
host_summaryChildren with severe neurologic compromise regardless of etiology should be assumed to aspirate until demonstrated otherwise.↗
▶Ep 2 · 2:32
host_summaryThe clinical significance of aspiration depends on the quantity—small isolated events are usually cleared by host defenses (cough, mucociliary transport), while large or repeated events overcome host defenses.↗
▶Ep 2 · 3:06
host_summaryA single aspiration event of caustic substance can have lifelong consequences.↗
▶Ep 2 · 3:31
clinicalChronic pulmonary aspiration is defined as repeated aspiration into the lower airways causing pulmonary injury or chronic respiratory disease, with consequences determined by frequency, magnitude, nature of material, and effectiveness of host defenses.↗
▶Ep 2 · 4:34
clinicalFour major groups aspirate: premature babies, those with neurologic disabilities, those with airway disease (anatomic, dynamic, or functional), and those with gastrointestinal disorders.↗
▶Ep 2 · 5:02
host_summarySyndromes with significant swallowing dysfunction include CHARGE, Cri-du-chat, Möbius syndrome (cranial nerve abnormalities), and craniofacial defects like Pfeiffer, Crouzon, and Treacher Collins.↗
▶Ep 2 · 44:25
host_summaryLipid-laden macrophages are the most commonly used aspiration biomarker, with a lipid-laden macrophage index >90 or >20% of macrophages containing lipid suggesting aspiration.↗
▶Ep 2 · 45:56
clinicalElevated lipid-laden macrophages are not pathognomonic of aspiration—they can result from natural airway debris (dead neutrophils, macrophages from inflammation) or circulation after bleeding or airway surgery.↗
▶Ep 2 · 46:38
clinicalLipid-laden macrophages are a limited tool because aspirated material has variable lipid content (saliva has no lipid), there is variable time between aspiration and BAL sampling affecting lipid metabolism, and individuals have variable rates of lipid catabolism.↗
▶Ep 2 · 48:08
host_summaryHaving a tracheostomy tube changes the dynamics of laryngeal elevation but most studies show it does not create aspiration.↗
▶Ep 2 · 49:10
clinicalDecanulation should not proceed until the child has proven capacity to clear their airway through a prolonged capping trial that includes going through illnesses without needing the tracheostomy for clearance.↗
▶Ep 2 · 49:10
quoteIt's not what you get in, it's how you get it out.↗
▶Ep 2 · 49:56
clinicalSpeaking valves help with airway clearance by allowing glottic closure for better cough and creating positive end-expiratory pressure that distends airways, even if they do not decrease aspiration coming in.↗
▶Ep 2 · 51:44
opinionThe pulmonologist's role in the aerodigestive team is to protect children from developing irreversible long-term pulmonary sequelae while managing anatomic abnormalities or waiting for maturity.↗
▶Ep 2 · 58:16
clinicalMedical management of functional aspiration should target five aspects: decrease aspiration events, improve airway clearance, address quality of aspirated material, control inflammation, and treat or prevent infections.↗
▶Ep 2 · 1:00:11
host_summaryFor airway clearance, comorbidities that compromise clearance include tracheobronchomalacia, airway compression/stenosis/hypoplasia, restrictive lung disease (neuromuscular, chest wall deformities, scoliosis), and vocal cord or diaphragmatic dysfunction/paralysis from esophageal or cardiac surgery.↗
▶Ep 2 · 1:02:17
clinicalChronic inflammation from aspiration is managed with inhaled steroids and systemic anti-inflammatory medication (azithromycin, not systemic steroids as first-line), with systemic steroids reserved for acute aspiration events to prevent pneumonitis.↗
▶Ep 2 · 1:03:30
clinicalPatients with bronchiectasis from chronic aspiration should receive longer antibiotic courses (10-14 days instead of 7-10 days) because bronchiectatic cavities have more difficult clearance.↗
▶Ep 2 · 1:03:42
clinicalProphylactic inhaled antibiotics (tobramycin or colistimethate, either every other month or 14 days per month) are reserved for patients with severe bronchiectasis and pulmonary injury or significant frequency of infections.↗
▶Ep 2 · 1:04:56
clinicalCuff tubes cannot stop aspiration because inflating the cuff enough to decrease leak causes unacceptable tracheal injury or dilation.↗
▶Ep 2 · 1:05:45
clinicalPositive pressure ventilation (CPAP or BiPAP) can decrease aspiration events, especially during sleep in patients with reflux aspiration, even in patients who do not need it for gas exchange or ventilation.↗
▶Ep 2 · 1:06:39
clinicalPassy-Muir valves should never be used during sleep because they allow inhalation through the tracheostomy but not exhalation, risking obstruction from mucus accumulation, and they cause over-drying of secretions leading to mucus plugging.↗
