Section 27. Disorders of the Respiratory System >
Part 2. Disorders of the Respiratory System >
Chapter 511. Aspiration SyndromesCori L. Daines
Topics Discussed: pulmonary aspiration; pulmonology and respiratory medicine.
Sections: Acute Aspiration, Chronic Recurrent Small-Volume Aspiration, References.
Excerpt:"Pulmonary aspiration is defined as the passage of foreign material
or fluid into the lungs during inspiration. Although food or gastric
contents are considered the main culprits, anything from saliva
to plastic toys can be aspirated. Aspiration of saliva and gastric
contents can occur in normal individuals silently, especially at night.1,2 The
true hazards of aspiration were not reported in the medical literature
until 1946 when Mendelson described the clinical and pathologic
findings in obstetric patients who aspirated large-volume gastric
contents. He described the "asthmalike" symptoms
of these patients and then showed in animal models that acidic material,
with pH less than 2.5, caused inflammation, damage, and desquamation
of the mucosa in the lungs.3 Pathologic aspiration
events can be divided into 2 main categories: acute and chronic.
The acute events include large-volume aspiration of gastric contents
or other fluid, hydrocarbon aspiration, near-drowning, and foreign
body aspiration. The chronic events include recurrent, small-volume
aspiration of saliva, food, upper airway secretions, or gastroesophageal
reflux. Large-volume aspiration events are usually witnessed and
can be directly addressed. Recurrent small-volume aspirations are
often silent and more difficult to diagnose and manage. It is important
to recognize the risk factors to properly diagnose aspiration (Table 511-1). ..."
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