Pulmonary aspiration
This article relies largely or entirely on a single source. (June 2010) |
Pulmonary aspiration | |
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Upper gastrointestinal series at the level of the esophagus, showing pulmonary aspiration of the radiocontrast agent | |
Specialty | Pulmonology |
Causes | Foreign body aspiration |
Pulmonary aspiration is the entry of material such as
Consequences of pulmonary aspiration range from no injury at all, to chemical pneumonitis or pneumonia, to death within minutes from asphyxiation. These consequences depend on the volume, chemical composition, particle size, and presence of infectious agents in the aspirated material, and on the underlying health status of the person.
In healthy people, aspiration of small quantities of material is common and rarely results in disease or injury. People with significant underlying disease or injury are at greater risk for developing respiratory complications following pulmonary aspiration, especially hospitalized patients, because of certain factors such as depressed level of consciousness and impaired airway defenses (
About 3.6 million cases of pulmonary aspiration or foreign body in the airway occurred in 2013.[1]
Presentation
Consequences
Pulmonary aspiration of particulate matter may result in acute airway obstruction which may rapidly lead to death from arterial hypoxemia.[2]
Pulmonary aspiration of acidic material (such as stomach acid) may produce an immediate primary injury caused by the chemical reaction of acid with lung parenchyma, and a later secondary injury as a result of the subsequent inflammatory response.[2]
Bacterial
Pulmonary aspiration may be followed by bacterial pneumonia. Community-acquired aspiration pneumonia is usually caused by anaerobic bacteria, whereas hospital-acquired aspiration pneumonia is more often caused by mixed flora, including both aerobic and anaerobic bacteria.[2]
Death
Pulmonary aspiration resulting in pneumonia, in some patients, particularly those with physical limitations, can be fatal.
Risk factors
Risk factors for pulmonary aspiration include conditions which depress the level of consciousness (such as
Prevention
The lungs are normally protected against aspiration by a series of protective reflexes such as
Measures to prevent aspiration depend on the situation and the patient. In patients at imminent risk of aspiration,
People with chronic neurological disorders, for example, after a stroke, are less likely to aspirate thickened fluids on an instrumental swallowing assessment. However, this does not necessarily translate into reduced risk of pneumonia in real life eating and drinking.[6] Also, pharyngeal residue is more common with very thickened fluids: this may subsequently be aspirated and lead to a more severe pneumonia.[7]
The location of
Management
See also:
Treatment of foreign body aspiration is determined by the age of the patient and the severity of obstruction of the airway involved.[8]
Basic management
An airway obstruction can be partial or complete. In partial obstruction, the patient can usually clear the foreign body with coughing.[8] In complete obstruction, acute intervention is required to remove the foreign body.[8]
If foreign body aspiration is suspected, finger sweeping in the mouth is not recommended due to the increased risk of displacing the foreign object further into the airway.[8]
For choking children less than 1 year of age, the child should be placed face down over the rescuer's arm.
Advanced management
In the event that the basic measures do not remove the foreign body, and adequate ventilation cannot be restored, need for treatment by trained personnel becomes necessary.[8] Laryngoscopy should be performed in unresponsive patients if non-invasive airway clearance techniques are unsuccessful.[9] Laryngoscopy involves placing a device in the mouth to visualize the back of the airway.[9] If the foreign body can be seen, it can be removed with forceps.[9] An endotracheal tube should then be placed in order to prevent airway compromise from resulting inflammation after the procedure.[9] If the foreign body cannot be visualized, intubation, tracheotomy, or needle cricothyrotomy can be done to restore an airway for patients who have become unresponsive due to airway compromise.[8]
If non-invasive measures do not dislodge the foreign body, and the patient can maintain adequate ventilation,
After the foreign body is removed, patients should receive nebulized beta-adrenergic medication and
Patients who are clinically stable with no need for supplemental oxygen after extraction may be discharged from the hospital the same day as the procedure.[11] Routine imaging such as a follow-up chest x-ray are not needed unless symptoms persist or worsen, or if the patient had imaging abnormalities previously to verify return to normal.[11] Most children are discharged within 24 hours of the procedure.[12]
See also
References
- PMID 26063472.
- ^ PMID 10655918.
- PMID 645722.
- S2CID 38174864.
- S2CID 12151704.
- ^ O'Keeffe ST. (July 2018). Use of modified diets to prevent aspiration in oropharyngeal dysphagia: is current practice justified? BMC Geriatrics. 2018;18:167 https://doi.org/10.1186/s12877-018-0839-7
- ^ Robbins J, Gensler G, Hind J, Logemann JA, Lindblad AS, Brandt D, et al. Comparison of 2 interventions for fluid aspiration on pneumonia incidence: a randomised trial. Ann Intern Med. 2008;148:509–18.
- ^ a b c d e f g h i j k l m n Cite error: The named reference
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Further reading
- Levy, D M (2006). "Pre-operative fasting—60 years on from Mendelson". Continuing Education in Anaesthesia, Critical Care & Pain. 6 (6): 215–8. .
- Mendelson, C. L. (1946). "The aspiration of stomach contents into the lungs during obstetric anesthesia". American Journal of Obstetrics and Gynecology. 52 (2): 191–205. PMID 20993766.