If
aspiration occurs, what are the usual course, treat-ment and prognosis?
If aspiration occurs, treatment is symptomatic.
The oral pharynx should be suctioned at the time of the aspiration. If the
patient is supine, the head should be turned to the side to facilitate
suctioning. The patient should also be placed in the Trendelenburg position to
allow pooling of the regurgitant in the oropharynx, thereby lessening the
volume aspirated. Irrigation of the airway is not advised since it may cause spreading of the aspirate and a more
profound pulmonary destruction. Bronchoscopy may be needed to remove large
particulate matter. Supplemental oxygen should be administered. Mechanical
ventilation is
β2 inhalers may be helpful for treatment of bronchospasm. The routine
use of steroids has not been shown to
be beneficial. Antibiotics should only be started after evidence of infection
by positive culture.
If a clinically significant aspiration has
occurred, signs usu-ally occur within 2 hours of the event. Signs include
bron-chospasm, a drop in oxygen saturation of greater than 10% from baseline on
room air, an alveolar-arterial (A-a) gradient of >300 mmHg on 100% O2,
and a chest radiograph usually revealing atelectasis or an infiltrate (most
commonly a right lower lobe infiltrate). Intrapulmonary damage can progress to
interstitial and alveolar edema, with hyaline membrane formation and
destruction of lung tissue. Adult respiratory distress syndrome (ARDS) often
occurs in patients requiring more than 24 hours of mechanical ventilation. The
progno-sis in patients with pulmonary aspiration is usually good if there is
good health preoperatively. A poor outcome has been associated with the
presence of significant comorbid conditions.
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