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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).
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Aspiration of
Foreign Bodies
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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 ...