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Aspiration of Gastric Contents

Aspiration Gastric Contents


Presentation

  • A case is presented of a 16-year-old girl with ectodermal dysplasia for whom dental surgery under general anaesthesia was planned.[ncbi.nlm.nih.gov]
  • We present a case report of a child who underwent general anaesthesia for elective surgery in whom regurgitation and aspiration of gastric contents were associated with the use of the laryngeal mask airway (LMA).[ncbi.nlm.nih.gov]
  • This article presents two incidents involving diving-related vomiting with associated aspiration of gastric contents.[ncbi.nlm.nih.gov]
  • An illustrative case report is presented.[ncbi.nlm.nih.gov]
  • The present experimental findings in animals and test subjects show that the nasogastric balloon tube can prevent gastroesophageal reflux under provocation of vomiting and regurgitation.(ABSTRACT TRUNCATED AT 250 WORDS).[ncbi.nlm.nih.gov]
Hypoxemia
  • These findings usually included fever, tachypnea, diffuse rales, and serious hypoxemia. Cough, cyanosis, wheezing, and apnea were each seen in approximately one third of the cases.[ncbi.nlm.nih.gov]
  • Pulmonary aspiration can present symptoms of wheezing, coughing, dyspnea, cyanosis, pulmonary edema, hypotension, and hypoxemia, which may progress rapidly to severe acute respiratory distress syndrome (ARDS).[kjccm.org]
  • The CXR is mottled and the patient is prone to develop hypoxemia secondary to right to left intrapulmonary shunting.[quizlet.com]
  • […] gastric tube (for example, a feeding tube ) may also increase the risk. [3] Consequences [ edit ] Particle-related [ edit ] Pulmonary aspiration of particulate matter may result in acute airway obstruction which may rapidly lead to death from arterial hypoxemia[en.wikipedia.org]
  • […] difficulty, noisy breathing Chest pain Rapid heartbeat Low grade fever Weight loss Fatigue Blue coloring, especially lips and nail beds Blood-streaked mucus Increased mucus production Increased white blood cell production Tachypnea Tachycardia Transient hypoxemia[cme.ucsd.edu]
Sudden Infant Death Syndrome
  • OBJECTIVE: To determine ante-mortem and post-mortem risk factors for the finding of gastric contents in pulmonary airways (aspiration of gastric contents) at post-mortem examination in the sudden infant death syndrome (SIDS).[ncbi.nlm.nih.gov]
Pathologist
  • People with difficulty swallowing should get and follow advice from a speech pathologist on foods that are safe to eat to prevent aspiration.[ada.com]
Cough
  • Prevention Most people can prevent it by having a strong cough. Physiotherapy can help to develop and maintain the coughing muscles.[ada.com]
  • Cough, cyanosis, wheezing, and apnea were each seen in approximately one third of the cases. Apena, shock, and early severe hypoxemia were particularly ominous events.[ncbi.nlm.nih.gov]
  • Pulmonary aspiration can present symptoms of wheezing, coughing, dyspnea, cyanosis, pulmonary edema, hypotension, and hypoxemia, which may progress rapidly to severe acute respiratory distress syndrome (ARDS).[kjccm.org]
  • Intrinsic Protective Airway Reflexes If gastric contents make it past the UES, four reflexes help mitigate aspiration: apnea with laryngospasm, coughing, expiration, and spasmodic panting. Laryngospasm initially adducts both ...[mhmedical.com]
  • Symptoms of aspiration include: Coughing, choking, wheezing, rapid breathing and bad breath.[healthcentral.com]
Respiratory Distress
  • Worsening of infiltrates after initial improvement was associated with the development of bacterial pneumonia, the adult respiratory distress syndrome, and pulmonary embolism.[ncbi.nlm.nih.gov]
  • Key Words: acute respiratory distress syndrome ; aspiration pneumonitis ; diffuse alveolar hemorrhage[kjccm.org]
  • Intubation is not required if there is no respiratory distress.[aast.org]
  • However, aspiration may cause: Chemical pneumonitis: chemical irritation of the lungs, which may progress to acute respiratory distress syndrome and/or bacterial infection.[patient.info]
Hoarseness
  • Pulmonary symptoms range from a subtle cough, wheezing, or hoarseness to severe dyspnea or asphyxiation. We discuss the mechanism of pulmonary disease caused by aspiration as well as the appropriate treatment.[link.springer.com]
Stridor
  • Bronchiectasis may follow. presentation of small particle partially obstructive aspiration is with dyspnoea, persistent coughing, wheeze, stridor and hypoxaemia non-obstructive particulate aspiration causes a clinical and radiological picture similar[aic.cuhk.edu.hk]
Rales
  • These findings usually included fever, tachypnea, diffuse rales, and serious hypoxemia. Cough, cyanosis, wheezing, and apnea were each seen in approximately one third of the cases.[ncbi.nlm.nih.gov]
Vomiting
  • This article presents two incidents involving diving-related vomiting with associated aspiration of gastric contents.[ncbi.nlm.nih.gov]
  • Twelve pigs with a blocked cardia did not show any gastroesophageal reflux under six different procedures to provoke vomiting and regurgitation (gastric fluid filling with different volumes, head-down positioning, drug-induced vomiting, external gastric[ncbi.nlm.nih.gov]
  • CONTEXT: Although a life-threatening complication, pulmonary aspiration of gastric contents caused by vomiting or regurgitation during induction of anaesthesia cannot be prevented.[ncbi.nlm.nih.gov]
  • Other risk factors for aspiration included vomiting (p .007), gastric feedings (p .009), a Glasgow Coma Scale score CONCLUSIONS: Aspiration of gastric contents is common in critically ill tube-fed patients and is a major risk factor for pneumonia.[ncbi.nlm.nih.gov]
  • This manifests as reddish streaks of fresh blood in the vomit content. Further Reading What is Vomiting? Vomiting Mechanism Vomit Content Vomiting Causes Vomiting Social Implications[news-medical.net]
Regurgitation
  • RESULTS: The incidence of regurgitation was 20%. Regurgitation was associated with radiological findings consistent with aspiration with a high specificity (81%) and a low sensitivity (46%).[ncbi.nlm.nih.gov]
  • The possible mechanisms causing regurgitation are discussed.[ncbi.nlm.nih.gov]
  • regurgitation and aspiration can be minimized.[ncbi.nlm.nih.gov]
  • The present experimental findings in animals and test subjects show that the nasogastric balloon tube can prevent gastroesophageal reflux under provocation of vomiting and regurgitation.(ABSTRACT TRUNCATED AT 250 WORDS).[ncbi.nlm.nih.gov]
  • Patients with both pH 3.5 and volume 25 mL were deemed to be at risk of acid aspiration should regurgitation occur.[ncbi.nlm.nih.gov]
Cyanosis
  • Cough, cyanosis, wheezing, and apnea were each seen in approximately one third of the cases. Apena, shock, and early severe hypoxemia were particularly ominous events.[ncbi.nlm.nih.gov]
  • Pulmonary aspiration can present symptoms of wheezing, coughing, dyspnea, cyanosis, pulmonary edema, hypotension, and hypoxemia, which may progress rapidly to severe acute respiratory distress syndrome (ARDS).[kjccm.org]
  • Clinically, this may be asymptomatic, or present as tachypnoea, bronchospasm, wheeze, cyanosis and respiratory insufficiency.[slideshare.net]
  • […] breathing Chest pain Rapid heartbeat Low grade fever Weight loss Fatigue Blue coloring, especially lips and nail beds Blood-streaked mucus Increased mucus production Increased white blood cell production Tachypnea Tachycardia Transient hypoxemia with cyanosis[cme.ucsd.edu]
  • […] can be helpful in this setting Classically, gastric acid aspiration occurs with atijeast 25 jcc of gastric contents (pH Mendelson's syndrome results from the aspiration of gastric acid, with the development of pulmonary edema, pulmonary hypertension, cyanosis[quizlet.com]
Suggestibility
  • CONCLUSIONS: Although there was a strong association between clinical regurgitation and radiological findings consistent with aspiration, our data suggest that regurgitation is not invariably followed by radiological findings compatible with aspiration[ncbi.nlm.nih.gov]
  • Previous studies suggest that pepsin in tracheal aspirates may be a valuable marker of occult aspiration. We sought to show the sensitivity and specificity of a new, pepsin-specific assay in humans.[ncbi.nlm.nih.gov]
  • CONCLUSIONS: The results of this study suggest that peptic activity in bronchoalveolar lavage fluid can be detected up to 60 mins after induced, experimental gastric juice aspiration and may prove a clinically useful biochemical marker for episodes of[ncbi.nlm.nih.gov]
  • A recent meta-analysis by Clark et al suggested that ranitidine was superior to PPIs in both reducing gastric fluid volume and acidity. Its use is recommended in patients at risk of aspiration only, not routinely.[slideshare.net]
  • Bouvet et al. have suggested a value of 0.8mL/kg as a cut-off based on animal studies and extrapolating the data to humans (11). On the other hand, Perlas et al. suggests that a value of 1.5mL/kg is more appropriate (12).[pocusjournal.com]
Withdrawn
  • After planned endotracheal and nasogastric intubation for elective surgery, 20 participants had tracheal and gastric aspirates withdrawn. A blinded investigator tested samples for the presence of pepsin using the assay.[ncbi.nlm.nih.gov]
Cesarean Section
  • Patients were randomized in a double-blind fashion to receive ranitidine, 50 mg intravenously, or placebo at the time of decision to proceed to cesarean section.[ncbi.nlm.nih.gov]
Seizure
  • · Defined as the passage of material from the oropharynx into the tracheobronchial tree · Predisposing conditions include: § CNS disorders § Intoxication or drug overdose § Seizure disorders § Recent anesthesia § Swallowing disorders § Poor oral care[learningradiology.com]
  • […] tract such as gastro-esophageal reflux, gastroparesis, bowel obstruction, and ileus Elderly and nursing home patients who have a high incidence of reflux disease, dysphagia, and poor oral hygiene Dysphagia from neurologic disorders including stroke, seizures[aast.org]
  • The following are considered to be independent risk factors for aspiration pneumonia: Impaired consciousness: drug or alcohol misuse, general anaesthesia, seizures, sedation, acute stroke, central nervous system lesions, head injury.[patient.info]
  • Most cases associated with predisposing factors (see “Risk Factors”) Risk Factors Reduced consciousness, alcoholism, seizures, general anesthesia, dementia/cognitive impairment, age 60 years, poor nutritional status, poor oral hygiene Choking incident[unboundmedicine.com]
  • […] of the esophagus or GI tract (stricture, gastroesophageal reflux (return to the index for documents on reflux and gastrointestinal disorders)) Immobility Poor body and head alignment Vomiting Decreased respiratory function History of pneumonia Stroke Seizures[cme.ucsd.edu]

Workup

Pulmonary Infiltrate
  • Patients with the most extensive radiographic abnormalities on initial studies tended to have the worst prognosis; however, mild early pulmonary infiltrates occasionally progressed to life-threatening abnormalities, and extensive initial involvement was[ncbi.nlm.nih.gov]
  • Definition Most cases of witnessed or otherwise recent aspiration of oropharyngeal or gastric contents associated with a new pulmonary infiltrate represent an acute chemical pneumonitis rather than an infection.[openanesthesia.org]

Treatment

  • Treatment from the outset by adrenocortical steroids or antimicrobial agents had no demonstrable effect on the outcome.[ncbi.nlm.nih.gov]
  • Treatment Treatment depends on the severity of the aspiration. The aspirated objects or objects may need to removed by using a flexible camera to look at the windpipes. If pneumonia occurs, antibiotics might be given.[ada.com]
  • […] nizatidine 150),NM (nizatidine 150 metoclopramide 10) Group C, F (famotidine 20 mg), and FM (famotidine 20 mg metoclopramide 10) Group C,S (lafutidine 10), SD (lafutidine 10 domperidone 10), and Group SM (lafutidine 10 metoclopramide 10) Other Names: Drug treatment[clinicaltrials.gov]
  • Larrain A, Carrasco J, Galleguillos J, Pope CE: Reflux treatment improves lung function in patients with intrinsic asthma (abstract). Gastroenterology 80 :1204, 1981 Google Scholar 12.[link.springer.com]
  • Treatment of Aspiration or Tracheostomy-associated Pneumonia in Neurologically Impaired Children: Effect of Antimicrobials Effective Against Anaerobic Bacteria. International Journal of Pediatric Otorhinolaryngology, 35(2) 171-177.[cme.ucsd.edu]

Prognosis

  • Patients with the most extensive radiographic abnormalities on initial studies tended to have the worst prognosis; however, mild early pulmonary infiltrates occasionally progressed to life-threatening abnormalities, and extensive initial involvement was[ncbi.nlm.nih.gov]
  • Treatment and prognosis differ by aspirated substance. Aspiration can cause lung inflammation (chemical pneumonitis), infection ( bacterial pneumonia or lung abscess ), or airway obstruction .[msdmanuals.com]
  • Prognosis This depends on the underlying cause, general well-being of the patient, presence of complications, speed of diagnosis and effective treatment.[patient.info]
  • Both community-acquired pneumonia (CAP) and hospital-acquired pneumonia have a worse prognosis if aspiration (defined by both clinical and radiologic features) is likely to be the inciting event ( 3 ).[unboundmedicine.com]

Etiology

  • Etiology and Pathophysiology Aspiration pneumonia occurs when organisms dwelling in the oropharynx or stomach are introduced into the lungs in sufficient volume to cause clinical disease of infection.[unboundmedicine.com]

Epidemiology

  • Objectives To use the UK Obstetric Surveillance System (UKOSS) to describe the epidemiology, risk factors and outcomes of maternal pulmonary aspiration in pregnancy in the UK.[npeu.ox.ac.uk]
  • Epidemiology It is common. One study of elderly patients implicated aspiration pneumonia in 10% or cases of community-acquired pneumonia [ 1 ].[patient.info]
  • Epidemiology Prevalence Prevalence data is difficult to assess given variations in the definition of aspiration pneumonia (radiographic, clinical, or bacteriologic classifications have all been used).[unboundmedicine.com]
Sex distribution
Age distribution

Pathophysiology

  • PATHOPHYSIOLOGY OF ASPIRATION Natural barriers to aspiration include the lower esophageal sphincter, the upper esophageal sphincter, and the intrinsic protective airway reflexes.[mhmedical.com]
  • We review the pathophysiology of each of these syndromes and discuss important diagnostic and therapeutic consequences. FULL TEXT[annals.org]
  • Ongoing basic science and clinical research are crucial for understanding the pathophysiology of aspiration-induced lung injury and developing novel therapeutic strategies.[aast.org]
  • Etiology and Pathophysiology Aspiration pneumonia occurs when organisms dwelling in the oropharynx or stomach are introduced into the lungs in sufficient volume to cause clinical disease of infection.[unboundmedicine.com]

Prevention

  • The maximum tilt used in this study was not adequate to prevent aspiration in the sniffing position.[ncbi.nlm.nih.gov]
  • These deaths can be prevented only by proper evaluation of the patient preoperatively and assuming that any patient dealt with in emergency has a full stomach until proven otherwise.[ncbi.nlm.nih.gov]
  • A new disposable nasogastric balloon tube was developed to prevent the reflux of gastric contents by blocking the cardia with a balloon. The effectiveness of this tube was investigated in animals and healthy volunteers.[ncbi.nlm.nih.gov]
  • A clear understanding of risk factor/s is needed to prevent further cases of pulmonary aspiration.[ncbi.nlm.nih.gov]
  • In order to prevent aspiration of gastric contents, a drainage tube was inserted into the stomach as a reconstructive organ and endotracheal intubation was maintained for more than 24 hours post-operatively in order to suction the tracheobronchial secretion[ncbi.nlm.nih.gov]

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