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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).

Table 511-1. Risk Factors for Aspiration

Aspiration of Foreign Bodies

Airway foreign body aspiration is an important cause of respiratory distress in children, especially those under 3 years of age. It is during this time that children become more mobile and have a tendency to put objects in their mouths. Food is the most common foreign body found in the airways of toddlers, while nonfood items are more common in older children and adolescents.4 Presenting symptoms include cough, wheeze, shortness of breath, and fever, sometimes temporally associated with a witnessed episode of choking. The diagnosis may be confused with pneumonia, asthma, bronchiolitis, or croup. Radiographs may show unilateral hyperinflation, mediastinal shift, atelectasis, or pneumonia, but they may be normal. When the airways are examined, the foreign object is often lodged in the bronchial airways, with the right-sided bronchi being the most common location. The object should be removed with rigid bronchoscopy, which maintains control of the airway and facilitates ventilation. Although fiberoptic bronchoscopy can examine more ...

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