'Aspiration of gastric contents'.

摘要

Macro-aspiration of gastric contents often presents with an acute onset, a characteristic similar to acute cardiovascular events. "Macro" refers to large volume. Residents may awaken from a recumbent position, present on morning nursing rounds, or regurgitate after a meal followed by shortness of breath, lower airway congestion and hypoxia. Episodes may be associated with post-prandial and/or recumbent "emesis," gastric material on the cheek, pillow or clothing, as well as displacement of a nasogas-tric tube. Following such an event, residents may display fever and infiltrates in characteristic aspiration segments. Aspiration that occurs in the recumbent position characteristically produces infiltrates located in the mid lung fields, including the posterior segment of the upper lobe and apical segments of the lower lobes, while aspiration in the upright position causes infiltrates in basilar segments.Not all aspiration episodes cause infiltrates. Symptoms may resolve rapidly (=<24 hours) following aspiration of gastric contents which should prompt consideration of limiting antibiotic exposure. It is our impression that pulmonary aspiration of gastric contents is a common syndrome in the nursing home. A paper by Doctors Mylotte and collaborators should be required reading. This work utilized a clinical algorithm to classify 170 acute care admissions from nursing homes with suspected pneumonia. 75% were classified as secondary to an aspiration event. In addition to sudden onset, vomiting and tube feeding, "aspiration" inclusion criteria included choking while eating and dysphagia.