Surgical Critical Care: Pulmonary Aspiration

Definitions

• Aspiration: Entry of Material into the Larynx & Lower Respiratory Tract
  • Includes Oropharyngeal Contents (Food/Drink) or Gastric Contents
• Aspiration (Chemical) Pneumonitis – Inflammatory Reaction in the Lower Airways
  • Independent of Infection
  • Mediated by Inflammatory Cytokines (TNF-α & IL-8)
  • Mendelson’s Syndrome – Aspiration Pneumonitis that Occurs During Anesthesia, Especially During Pregnancy
• Aspiration (Bacterial) Pneumonia – Active Bacterial Infection
  • Most Common Site: Superior Segment of Right Lower Lobe (RLL)

Risk Factors

• Dysphagia
• Head, Neck & Esophageal Tumors
• Esophageal Structure
• Esophageal Motility Disorders
• COPD
• Seizures
• Degenerative Neurologic Disease (Multiple Sclerosis, Parkinson’s Disease, Dementia)
• Altered Mental Status
• Stroke
• Antipsychotic Medication
• Cardiac Arrest

Diagnosis

• Primary a Clinical Diagnosis (Based on Clinical History, Exam & Chest X-Ray)
• Bronchoalveolar Lavage (BAL) May Be Used to Distinguish Pneumonia from Pneumonitis

Treatment

• Mild-Moderate Cases: Supportive Therapy & Reassess After 48 Hours
  • Aspiration Pneumonitis Itself Does Not Require Antibiotic Therapy
  • Even if Radiographic Infiltrate Present
• Severe Cases: Empiric ABX
• *Bronchoscopy Not Routinely Required Unless There was a Large-Volume Witnessed Aspiration