Pulmonary aspiration

Abstract 

Aspiration may be defined as the inhalation of material below the true vocal cords. It occurs in patients with high gastric volumes or an incompetent lower oesophageal sphincter, or in those patients whose protective airway reflexes have been lost. Patients are most at risk during induction, emergence, and in the emergency situation. Aspiration causes a chemical pneumonitis, and particulate matter may cause airway obstruction. Consequences of aspiration include atelectasis, pulmonary oedema, VQ mismatching and the development of acute respiratory disease syndrome. The clinical presentation covers a wide spectrum and is influenced by the nature, pH and volume of the aspirate. Acute management includes airway suction, oxygen therapy and securing the airway if the patient is unconscious. Bronchoscopy may be required for large foreign bodies or semi-solid material in the airway. Those patients who develop clinical sequelae within 2 hours of aspirating require admission to high-level care for further treatment. Bronchodilators and physiotherapy are appropriate treatments. Antibiotics should only be given if infected matter is inhaled or if subsequent infection develops. Steroids do not improve outcome. Severe cases will require ventilation and management in intensive care. Mortality in those who develop symptoms is about 10%.

Keywords: critical incident, management, pneumonitis