Pulmonary aspiration

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Pulmonary aspiration

In medicine

Medicine

Medicine is the art and science of healing. It encompasses a range of health care practices evolved to maintain and restore health by the prevention and treatment of illness....
, aspiration is the entry of secretions or foreign material into the trachea

Vertebrate trachea

The traceartes, or windpipe, is a tube that has an inner diameter of about 20-25 mm and a length of about 10-16 cm in humans. It commences at the larynx and bifurcates into the primary bronchus in mammals, and from the pharynx to the syrinx in birds, allowing the passage of air to the lungs....
and lung

Lung

The lung is the essential respiration organ in air-breathing animals, including most tetrapods, a few fish and a few snails. In mammals and the more complex life forms, the two lungs are located in the chest on either side of the heart....
s.

The patient may either inhale

Inhalation

Inhalation is the movement of air from the external environment, through the air ways, and into the alveoli.Inhalation begins with the onset of contraction of the diaphragm , which results in expansion of the intrapleural space and an increase in negative pressure according to Boyle's Law....
the material, or it may be blown into the lungs during positive pressure ventilation

Positive pressure ventilation

In emergency medicine positive pressure ventilation refers to the process of forcing air into the lungs of a patient, usually using a Bag valve mask or mechanical ventilator....
or CPR. As the right main bronchus

Bronchus

A bronchus is a caliber of airway in the respiratory tract that conducts air into the lungs.No gas exchange takes place in this part of the lungs....
is more vertical and of slightly wider lumen

Lumen (anatomy)

A lumen in biology is the inside space of a tubular structure, such as an artery or intestine. By extension, a lumen can also be the inside space of a cellular component or structure, such as the endoplasmic reticulum....
than the left, aspirated material is more likely to end up in this branch or one of its subsequent bifurcation

Bifurcation

Bifurcation means the splitting of a main body into two parts.Bifurcation or Bifurcated may refer to:*Bifurcation , the division of issues in a trial for example the division of a page into two parts....
s.

rule of thumb, any condition which compromises a patient's level of consciousness and/or gag reflex

Gag reflex

The pharyngeal reflex or gag reflex is a reflex contraction of the back of the throat, evoked by touching the soft palate. It prevents something from entering the throat except as part of normal swallowing and helps prevent choking....
is a risk factor for pulmonary aspiration.

Causes of unconsciousness where aspiration may occur include trauma

Trauma

Trauma can represent:...
(especially head injuries), poisoning

Poisoning

Poisoning may mean:*For biology toxicity, see toxin and poison* Catalyst poisoning* Nuclear poison* Chinese_food_therapy#Cantonese_classification_of_food, a classification in Cantonese food...
(including drug/alcohol overdose), general anaesthetic

General anaesthetic

A general anaesthetic drug is an anaesthetic drug that brings about a reversible loss of consciousness. These drugs are generally administered by an anesthesia provider in order to induce or maintain general anaesthesia to facilitate surgery....
s, and diseases or metabolic conditions.

Gastroesophageal reflux, a full stomach, pregnancy

Pregnancy

Pregnancy is the carrying of one or more offspring, known as a fetus or embryo, inside the uterus of a female. In a pregnancy, there can be multiple gestations, as in the case of twins or Multiple birth....
, and obesity

Obesity

Obesity is a condition in which excess body fat has accumulated to an extent that health may be negatively affected. It is commonly defined as a body mass index of 30 kg/m2 or higher....
all increase the risk of aspiration in the semiconscious.

Normally fasting

Fasting

Fasting is primarily the act of willingly abstaining from some or all food, drink, or both, for a period of time. A fast may be total or partial concerning that from which one fasts, and may be prolonged or intermittent as to the period of fasting....
for six hours before elective surgery is enough to empty the stomach.

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Encyclopedia

In medicine

Medicine

Vertebrate trachea

Lung

Inhalation

Positive pressure ventilation

Bronchus

A bronchus is a caliber of airway in the respiratory tract that conducts air into the lungs.No gas exchange takes place in this part of the lungs....
is more vertical and of slightly wider lumen

Lumen (anatomy)

Bifurcation

Risk factors

As a rule of thumb, any condition which compromises a patient's level of consciousness and/or gag reflex

Gag reflex

Trauma

Trauma can represent:...
(especially head injuries), poisoning

Poisoning

General anaesthetic

Pregnancy

Obesity

Fasting

Duodenum

The duodenum is the first section of the small intestine in most higher vertebrates, including mammals, reptiles, and birds. In fish, the divisions of the small intestine are not as clear and the terms anterior intestine or proximal intestine may be used instead of duodenum....
.

Acute alcohol poisoning is a relatively common cause of severe pulmonary aspiration as the alcohol renders the victim unconscious and can induce vomiting. Patients with neurological conditions may also aspirate food or drink.

During labour (childbirth

Childbirth

Childbirth is the culmination of a human pregnancy or gestation period with the delivery of one or more newborn infants from a woman's uterus. The process of normal human childbirth is categorized in three stages of labour: the shortening and dilation of the cervix, descent and delivery of the infant, and delivery of the placenta.....
), early respiratory movements by the baby facilitate filling of alveolar duct

Alveolar duct

Alveolar ducts are the tiny end ducts of the branching airways that fill the lungs. Each lung holds approximately 1.5 to 2 million of them. The tubules divide into two or three alveolar sacs at the distal end....
s and alveolar lumens with elements of amniotic fluid

Amniotic fluid

Amniotic fluid or liquor amnii is the nourishing and protecting liquid contained by the amnion of a pregnant woman.Amnion grows and begins to fill, mainly with water, around two weeks after fertilization....
: amniotic cells, squamous and squamous cells from fetal skin, lanugo

Lanugo

Lanugo is fine, downy hair; it is a type of pelage....
, meconium

Meconium

Meconium is the earliest Human feces of an infant. Unlike later feces, meconium is composed of materials ingested during the time the infant spends in the uterus: intestinal epithelial cells, lanugo, mucus, amniotic fluid, bile, and water....
. Reduced inflammatory infiltrate (neutrophils) and capillary

Capillary

Capillaries are the smallest of a body's blood vessels, measuring 5-10 micrometre in diameter, which connect arterioles and venules, and enable the interchange of water, oxygen, carbon dioxide, and many other nutrient and waste chemical substances between blood and surrounding tissue s....
congestion is present.

Consequences

If enough material enters the lungs, the patient may simply drown. However, small volumes of gastric acid contents can fatally damage the delicate lung tissue. Even small volumes of aspirated food may lead to bronchopneumonia

Bronchopneumonia

Bronchopneumonia is a type of pneumonia characterized by multiple foci of isolated, acute consolidation, affecting one or more pulmonary lobes....
infection. Chronic aspiration may lead to bronchiectasis

Bronchiectasis

Bronchiectasis is a disease that causes localized, irreversible dilation of part of the bronchial tree. It is classified as an obstructive lung disease, along with bronchitis and cystic fibrosis....
and may cause some cases of asthma

Asthma

Asthma is a common chronic obstructive pulmonary disease, in which the Lung constrict, become inflammation, and are lined with excessive amounts of thickened mucus, often in response to one or more triggers....
.

Prevention

The lungs are normally protected against aspiration by a series of protective reflexes such as coughing and swallowing

Swallowing

"Gulp" redirects here. For other uses, see Gulp .Swallowing, known scientifically as deglutition, is the process in the human or animal body that makes something pass from the mouth, to the pharynx, into the esophagus, with the shutting of the epiglottis....
. Significant aspiration can only occur if the protective reflexes are absent (in neurological disease, coma

Coma

In medicine, a coma is a profound state of unconsciousness. A comatose person cannot be awakened, fails to respond normally to pain or light, does not have sleep-wake cycles, and does not take voluntary actions....
, drug overdose

Drug overdose

The term drug overdose describes the ingestion or application of a drug or other substance in quantities greater than are recommended or generally practiced....
, sedation

Sedation

Sedation is a medical procedure involving the administration of sedative drugs, generally to facilitate a medical procedure with local anaesthesia....
or general anesthesia). In intensive care, sitting patients up reduces the risk of pulmonary aspiration and ventilator associated pneumonia

Pneumonia

Pneumonia is an Inflammation illness of the lung. Frequently, it is described as lung parenchyma/alveolus inflammation and abnormal alveolar filling with fluid ....
.

Measures to prevent aspiration depend on the situation and the patient. In patients at imminent risk of aspiration, endotracheal intubation

Intubation

In medicine, intubation refers to the placement of a tube into an external or internal orifice of the body. Although the term can refer to endoscopy procedures, it is most often used to denote tracheal intubation....
by a trained health professional provides the best protection. A simpler intervention that can be implemented is to lay the patient on their side in the rescue position (as taught in first aid

First aid

First aid is the provision of initial care for an illness or injury. It is usually performed by a layman to a sick or injured Casualty until definitive medical treatment can be accessed....
and CPR classes), so that any vomitus produced by the patient will drain out their mouth instead of back down their pharynx

Pharynx

FunctionsThe pharynx is part of the digestive system and respiratory system of many organisms.Because both food and Earth's atmosphere pass through the pharynx, a flap of connective tissue called the epiglottis closes over the trachea when food is swallowed to prevent choking or Pulmonary aspiration....
. Some anesthetists will use sodium citrate (to neutralise the stomach's high pH) and Metoclopramide (a pro-kinetic, to empty the stomach).

People with chronic neurological disorders, for example, after a stroke, are less likely to aspirate thickened fluids

Thickened fluids

Thickened fluids are often used for people with dysphagia, a disorder of swallowing function. The thicker consistency makes it less likely that an individual with dysphagia will pulmonary aspiration while they are drinking....
.

The location of abscess

Abscess

An abscess is a collection of pus that has accumulated in a cavity formed by the tissue on the basis of an infection process or other foreign materials ....
es caused by aspiration depends on the position one is in. If one is sitting or standing up, the aspirate ends up in the posterior basal segment of the right lower lobe. If one is on one's back, it goes to the superior segment of the right lower lobe. If one is lying on the right side, it goes to the superior segment of the right middle lobe, or the posterior basal segment of the right upper lobe. If one is lying on the left, it goes to the lingula

Lingula of left lung

According to most sources, there is no middle lobe in the left lung as there is in the right lung. However, the term lingula is used to denote a projection of the upper lobe of the left lung that serves as the homologue, and some sources define this as a distinct lobe....
.

Pulmonary aspiration

Risk factors

Consequences

Prevention

See also

External links