There are three types of aspiration:
- Large foreign bodies or food
- Liquid aspiration
- Bacterial aspiration
Aspiration of solid particles leads to atelectasis and/or
recurrent post-obstructive pneumonia. Consequences to liquid aspiration vary
depending on the nature of liquid. Acidic stomach contents can lead to diffuse
alveolitis and ARDS. Bacterial aspiration leads to lung abscess.
Common predisposing states for aspiration are
- defective deglutition reflex
- esophageal disease
- drug overdose
- post-op state
Children are prone to aspiration.
Aspiration should be considered if the clinical setting is
appropriate in the differential of atelectasis, recurrent pneumonia, ARDS and lung
- Bronchoscopy to remove the foreign body should be considered in
patients with atelectasis or recurrent pneumonia.
- ARDS is managed as usual with oxygen, PEEP and ventilators. Large doses of steroids
are considered beneficial in the first 24 hours following aspiration.
- Therapy for anaerobic infection should be considered in patients
with foul smelling sputum and when the aspiration occurred in a community setting. If the
abscess or pneumonia follows aspiration in a hospitalized patient, gram negative
coverage should be initiated.