Acute aspiration - Symptoms, Causes, Images, and Treatment Options

Diseases

Highlights & Basics

Key Highlights

The inhalation of foreign material into the airways beyond the vocal cords.
Usually occurs in patients with altered level of consciousness, dysphagia, or impaired cough reflex.
Patients with risk factors for aspiration should undergo a bedside clinical exam before feeding.
Anesthesia-related aspiration of gastric contents can be prevented by identifying patients susceptible to vomiting and reflux, minimizing gastric contents before surgery, minimizing emetic stimuli, and avoiding complete loss of protective reflexes from oversedation.
Antibiotics are not indicated early after aspiration of gastric contents but they should be considered if the pneumonitis does not resolve after 48 hours.

A. Portable upright chest x-ray before aspiration; B. Chest x-ray 1 hour after aspiration, showing bilateral diffuse alveolar infiltrates, worse at the bases on the right side

From the collection of Dr Henri Colt

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History & Exam
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Definition

Epidemiology

Etiology

Pathophysiology

Images

Bronchoscopy showing barium aspiration in a lung transplant patient in the right mainstem bronchus after a barium swallow study
A. Portable upright chest x-ray before aspiration; B. Chest x-ray 1 hour after aspiration, showing bilateral diffuse alveolar infiltrates, worse at the bases on the right side

Citations

Key Articles

Marik PE. Aspiration pneumonitis and aspiration pneumonia. N Engl J Med. 2001 Mar 1;344(9):665-71.[Abstract]
Ng A, Smith G. Gastroesophageal reflux and aspiration of gastric contents in anesthetic practice. Anesth Analg. 2001 Aug;93(2):494-513.[Abstract][Full Text]
Metheny NA, Clouse RE, Chang YH, et al. Tracheobronchial aspiration of gastric contents in critically ill tube-fed patients: frequency, outcomes, and risk factors. Crit Care Med. 2006 Apr;34(4):1007-15.[Abstract][Full Text]
Smith Hammond CA, Goldstein LB. Cough and aspiration of food and liquids due to oral-pharyngeal dysphagia: ACCP evidence-based clinical practice guidelines. Chest. 2006 Jan;129(1 suppl):154S-68S.[Abstract][Full Text]
Boyd M, Chatterjee A, Chiles C, et al. Tracheobronchial foreign body aspiration in adults. South Med J. 2009 Feb;102(2):171-4.[Abstract]
Paintal HS, Kuschner WG. Aspiration syndromes: 10 clinical pearls every physician should know. Int J Clin Pract. 2007 May;61(5):846-52.[Abstract]
Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: Application to healthy patients undergoing elective procedures: an updated report by the American Society of Anesthesiologists Task Force on preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration. Anesthesiology. 2017 Mar;126(3):376-93.[Abstract][Full Text]
Australian and New Zealand Society for Geriatric Medicine. Australian and New Zealand Society for Geriatric Medicine. Position statement - dysphagia and aspiration in older people. Australas J Ageing. 2011 Jun;30(2):98-103.[Abstract]

Referenced Articles

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