Aspiration syndromes
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Definition ,Causes ,presentation ,treatment ,prevention

Definition ,Causes ,presentation ,treatment ,prevention

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Aspiration syndromes Presentation Transcript

  • 1. Aspiration SyndromesProf. Dr. Saad S Al AniSenior Pediatric ConsultantHead of Pediatric departmentKhorfakkan HospitalSharjah ,UAEsaadsalani@yahoo.com
  • 2. Introduction“ Aspiration includes a wide clinicalspectrum from:An asymptomatic conditiontoAcute life-threatening events „5/27/2013Aspiration syndrome Prof.Dr.Saad S Al AniKhorfakkan Hospital Sharjah UAE
  • 3. Cont.“Acute life-threatening events, such asoccur with:i. Massive aspiration of gastric contentsorii. Hydrocarbon products „5/27/2013Aspiration syndrome Prof.Dr.Saad S Al AniKhorfakkan Hospital Sharjah UAE
  • 4. Cont.“ Occult aspiration of nasopharyngealsecretions into the lower respiratorytract is a normal event in healthy people,usually without apparent clinicalsignificance „5/27/2013Aspiration syndrome Prof.Dr.Saad S Al AniKhorfakkan Hospital Sharjah UAE
  • 5. Aspiration of gastric contents“ Large-volume aspiration of gastriccontents usually occurs in the context ofvomiting „5/27/2013Aspiration syndrome Prof.Dr.Saad S Al AniKhorfakkan Hospital Sharjah UAE
  • 6. Cont.“ It is an infrequent complication of* General anesthesia* Gastroenteritis* Altered level of consciousness „5/27/2013Aspiration syndrome Prof.Dr.Saad S Al AniKhorfakkan Hospital Sharjah UAE
  • 7. Cont.“ Increased clinical severity is noted withvolumes greater than approximately 0.8mL/kg and/or pH <2.5 „5/27/2013Aspiration syndrome Prof.Dr.Saad S Al AniKhorfakkan Hospital Sharjah UAE
  • 8. Cont.“After massive aspiration, the followingsoccur rapidly :i. Hypoxemiaii. Hemorrhagic pneumonitisiii. Atelectasisiv. Intravascular fluid shifts, andPulmonary edema „5/27/2013Aspiration syndrome Prof.Dr.Saad S Al AniKhorfakkan Hospital Sharjah UAE
  • 9. Cont.“ Most clinical changes are present withinminutes to 1-2 hr after the aspirationevent „5/27/2013Aspiration syndrome Prof.Dr.Saad S Al AniKhorfakkan Hospital Sharjah UAE
  • 10. Cont.“In the next 24-48 hr, there is :1. Marked increase in lung parenchymalneutrophil infiltrations2. Mucosal sloughing3. Alveolar consolidationThat often correlates with increasinginfiltrates on chest radiographs „5/27/2013Aspiration syndrome Prof.Dr.Saad S Al AniKhorfakkan Hospital Sharjah UAE
  • 11. Cont.“Infection usually does not have a role ininitial lung injury after aspiration of gastriccontents „“Aspiration may impair pulmonary defenses,predisposing the patient to secondarybacterial pneumonia „5/27/2013Aspiration syndrome Prof.Dr.Saad S Al AniKhorfakkan Hospital Sharjah UAE
  • 12. Cont.“In the patient who has shown clinicalimprovement but then demonstratesclinical worsening, especially with feverand leukocytosis , secondary bacterialpneumonia should be suspected „5/27/2013Aspiration syndrome Prof.Dr.Saad S Al AniKhorfakkan Hospital Sharjah UAE
  • 13. Treatment“If large-volume or highly toxic substanceaspiration occurs in a patient who alreadyhas an artificial airway in place, it isimportant to perform immediate suctioningof the airway „5/27/2013Aspiration syndrome Prof.Dr.Saad S Al AniKhorfakkan Hospital Sharjah UAE
  • 14. Cont.“Attempts at acid neutralization are notwarranted because acid is rapidlyneutralized by the respiratory epithelium „5/27/2013Aspiration syndrome Prof.Dr.Saad S Al AniKhorfakkan Hospital Sharjah UAE
  • 15. Cont.“ Patients in whom large volume or toxicaspiration is suspected should:i. Be observedii. Undergo oxygenation measurement byoximetry or blood gas analysisiii. Undergo a chest radiograph, even ifthey are asymptomatic „5/27/2013Aspiration syndrome Prof.Dr.Saad S Al AniKhorfakkan Hospital Sharjah UAE
  • 16. Cont.“ If the chest radiograph findings andoxygen saturation are normal, and thepatient remains asymptomatic , homeobservation, after a period of observationin the hospital or office, is adequate „5/27/2013Aspiration syndrome Prof.Dr.Saad S Al AniKhorfakkan Hospital Sharjah UAE
  • 17. Cont.“For patients who present with abnormalfindings or in whom such findings developduring observation, oxygen therapy isgiven to correct hypoxemia„“Endotracheal intubation and mechanicalventilation are often necessary for moresevere cases „5/27/2013Aspiration syndrome Prof.Dr.Saad S Al AniKhorfakkan Hospital Sharjah UAE
  • 18. Cont.“Bronchodilators may be tried, althoughthey are usually of limited benefit„“Prophylactic antibiotics are not indicated,although in the patient with very limitedreserve, early antibiotic coverage may beappropriate„5/27/2013Aspiration syndrome Prof.Dr.Saad S Al AniKhorfakkan Hospital Sharjah UAE
  • 19. Cont.“If used, antibiotics should be selected thatcover for anaerobic microbes „“If the aspiration event occurs in ahospitalized or chronically ill patient,coverage of Pseudomonas and entericgram-negative organisms should also beconsidered. „5/27/2013Aspiration syndrome Prof.Dr.Saad S Al AniKhorfakkan Hospital Sharjah UAE
  • 20. Cont.“A mortality rate of ≤5% is seen if 3 orfewer lobes are involved„“Unless complications develop, such asinfection or barotrauma, most patientsrecover in 2-3 wk, although prolonged lungdamage may persist, with scarring,bronchiolitis obliterans, and bronchiectasis„5/27/2013Aspiration syndrome Prof.Dr.Saad S Al AniKhorfakkan Hospital Sharjah UAE
  • 21. Prevention“ Prevention of aspiration should always bethe goal when airway manipulation isnecessary for intubation or other invasiveprocedures. „5/27/2013Aspiration syndrome Prof.Dr.Saad S Al AniKhorfakkan Hospital Sharjah UAE
  • 22. Cont.“ 1.Feeding with enteral tubes passed beyondthe pylorus2. Elevating the head of the bed 30-45 inmechanically ventilated patients3. Oral decontamination have been shownto reduce the incidence of aspirationcomplications in the intensive care unit „5/27/2013Aspiration syndrome Prof.Dr.Saad S Al AniKhorfakkan Hospital Sharjah UAE
  • 23. Cont.“ 1.Minimizing use of sedation2.Monitoring for gastric residuals3.Gastric acid suppressionmay all help prevent aspiration. „5/27/2013Aspiration syndrome Prof.Dr.Saad S Al AniKhorfakkan Hospital Sharjah UAE
  • 24. Cont.“Any patient with altered consciousness,especially one who is receiving tubefeedings, should be considered at high riskfor aspiration „5/27/2013Aspiration syndrome Prof.Dr.Saad S Al AniKhorfakkan Hospital Sharjah UAE
  • 25. Hydrocarbon aspiration“ The most dangerous consequence of acutehydrocarbon ingestion is usually aspirationand resulting pneumonitis „“Significant pneumonitis occurs in <2% ofall hydrocarbon ingestions „5/27/2013Aspiration syndrome Prof.Dr.Saad S Al AniKhorfakkan Hospital Sharjah UAE
  • 26. Cont.“Hydrocarbons with lower surface tensions(gasoline, turpentine, naphthalene) havemore potential for aspiration toxicity thanheavier mineral or fuel oils „5/27/2013Aspiration syndrome Prof.Dr.Saad S Al AniKhorfakkan Hospital Sharjah UAE
  • 27. Cont.“Ingestion of >30 mL (approximate volumeof an adult swallow) of hydrocarbonisassociated with an increased risk of severepneumonitis „5/27/2013Aspiration syndrome Prof.Dr.Saad S Al AniKhorfakkan Hospital Sharjah UAE
  • 28. Clinical findings“Clinical findings such as chest retractions,grunting, cough, and fever may occur assoon as 30 min after aspiration or may bedelayed for several hours „“Lung radiographic changes usually occurwithin 2-8 hr, peaking in 48-72 hr „5/27/2013Aspiration syndrome Prof.Dr.Saad S Al AniKhorfakkan Hospital Sharjah UAE
  • 29. Cont.“Pneumatoceles and pleural effusions mayoccur„“Patients presenting with: cough, shortnessof breath, or hypoxemia are at high risk forpneumonitis „5/27/2013Aspiration syndrome Prof.Dr.Saad S Al AniKhorfakkan Hospital Sharjah UAE
  • 30. Cont.“Other organ systems, especially the liver,central nervous system, and heart, maysuffer serious injury „“Cardiac dysrhythmias may occur and maybe exacerbated by: hypoxia and acid-baseor electrolyte disturbances „5/27/2013Aspiration syndrome Prof.Dr.Saad S Al AniKhorfakkan Hospital Sharjah UAE
  • 31. Treatment“Gastric emptying is nearly alwayscontraindicated because the risk ofaspiration is greater than any systemictoxicity „“Treatment is generally supportive,consisting of: oxygen, fluids, andventilatory support as necessary „5/27/2013Aspiration syndrome Prof.Dr.Saad S Al AniKhorfakkan Hospital Sharjah UAE
  • 32. Cont.“ The child who has no symptoms andnormal chest radiograph findings shouldbe observed for 6-8 hr to ensure safedischarge „“Certain hydrocarbons have more inherentsystemic toxicity „5/27/2013Aspiration syndrome Prof.Dr.Saad S Al AniKhorfakkan Hospital Sharjah UAE
  • 33. Cont.“The pneumonic CHAMP referscollectively to the following hydrocarbons:Camphor, Halogenated carbons , Aromatichydrocarbons, and those associated withMetals and Pesticides „5/27/2013Aspiration syndrome Prof.Dr.Saad S Al AniKhorfakkan Hospital Sharjah UAE
  • 34. Cont.“ Patients who ingest these compounds involumes >30 mL, such as might occur withintentional overdose, may benefit fromgastric emptying „5/27/2013Aspiration syndrome Prof.Dr.Saad S Al AniKhorfakkan Hospital Sharjah UAE
  • 35. Cont.“If a cuffed endotracheal tube can be placedwithout inducing vomiting, this procedureshould be considered, especially in thepresence of altered mental status „5/27/2013Aspiration syndrome Prof.Dr.Saad S Al AniKhorfakkan Hospital Sharjah UAE
  • 36. Cont.“Other substances that are particularly toxicand cause significant lung injury whenaspirated or inhaled include: baby powder,chlorine, shellac, beryllium, and mercuryvapors „5/27/2013Aspiration syndrome Prof.Dr.Saad S Al AniKhorfakkan Hospital Sharjah UAE
  • 37. Cont.“Repeated exposure to low concentrationsof these agents can lead to chronic lungdisease, such as:i. Interstitial pneumonitisandii. Granuloma formation „5/27/2013Aspiration syndrome Prof.Dr.Saad S Al AniKhorfakkan Hospital Sharjah UAE
  • 38. Cont.“Corticosteroids may:i. Help reduce fibrosis developmentii. Improve pulmonary functionalthough the evidence for this benefit islimited „5/27/2013Aspiration syndrome Prof.Dr.Saad S Al AniKhorfakkan Hospital Sharjah UAE
  • 39. Cont.“Aspirated and a chestradiograph the patient wasthought to have was obtainedimmediately (upperradiograph).The lungs areclear. Another chestradiograph was obtained twohours later (lowerradiograph) and now showsairspace disease in the rightlower lobe „http://www.learningradiology.com5/27/2013Aspiration syndrome Prof.Dr.Saad S Al AniKhorfakkan Hospital Sharjah UAE
  • 40. Cont.“Anteroposterior view of the chestof 14-month-old boy 30 hoursafter ingesting lamp oil. Note thecentral right lower lobe infiltrateobscuring the right heart border „http://emedicine.medscape.com5/27/2013Aspiration syndrome Prof.Dr.Saad S Al AniKhorfakkan Hospital Sharjah UAE
  • 41. References• Vale J, Kulig K: American Academy of Clinical Toxicology; European Association of PoisonsCentres and Clinical Toxicologists: Position paper: gastric lavage. J Toxicol ClinToxicol 2004; 42:933-943.• Jöhr M: Anaesthesia for the child with a full stomach. Curr Opin Anaesthesiol 2007; 20:201-203• Colombo JL, Thomas HM: Aspiration syndromes. In: Taussig LM, Landau LI, ed. Pediatricrespiratory medicine, ed 2. Philadelphia: Mosby/Elsevier; 2008:337-345• http://www.learningradiology.com• http://emedicine.medscape.com• Kliegman, Robert, Nelson, Waldo E.: Nelson textbook of pediatrics, 19th ed. Saunders,Philadelphia, USA . 20115/27/2013Aspiration syndrome Prof.Dr.Saad S Al AniKhorfakkan Hospital Sharjah UAE
  • 42. “Thank you„5/27/2013Aspiration syndrome Prof.Dr.Saad S Al AniKhorfakkan Hospital Sharjah UAE