Aspiration pneumonia is a life-threatening complication resulting from the inhalation of airway contaminants and pathogen overgrowth. Multiple substances are directly toxic to the lungs or can stimulate an inflammatory response when aspirated—gastric acid from vomiting is the most common aspirated substance.
It is common for healthy people to aspirate small amounts of oral secretions. Normal defense mechanisms usually clear the aspirate and contaminants without the progression of disease or inflammation. However, aspiration of larger amounts, or aspiration in a patient with impaired pulmonary defenses, often leads to aspiration pneumonia.
Aspiration pneumonia treatment guidelines for prehospital and EMS personnel include strategies to prevent aspiration to improve patient care and overall clinical outcomes. Prevention is the overall theme here—immediate orotracheal suctioning, oxygenation strategies, and handoff reporting procedures are all important aspects to review when looking at EMS aspiration pneumonia treatment guidelines.
The single best technique for the prevention of aspiration pneumonia is to swiftly and efficiently remove any contaminants in the patient’s airway before they are aspirated. Dr. James DuCanto developed the innovative suction-assisted laryngoscopy and airway decontamination (SALAD) technique, which calls for continuous and constant removal of blood, vomit, and other materials by the SSCOR DuCanto Catheter.
Using the SSCOR DuCanto Catheter and implementing the SALAD technique will greatly increase your chance of removing the potential aspirate before it reaches the patient’s lungs. Be mindful that mortality from aspiration pneumonia is related to the volume and content of the aspirate and is reported to be as high as 70%. Swift and efficient decontamination of the airway is a matter of life and death for your patient!
Although orotracheal suctioning is the first priority for preventing aspiration pneumonia according to treatment guidelines, there are other strategies you can implement or keep in mind when caring for a patient who is at risk for aspiration or who has already aspirated.
In an ideal world, you would preoxygenate all of your patients with 100 percent oxygen before suctioning.
Unfortunately, you know that the world of EMS is not always ideal.
Preoxygenation is simply not possible at all times. Preventing aspiration pneumonia means acting swiftly and almost instantly to any contaminants in your patient’s airway. By the time you preoxygenate, your patient may have already aspirated. Use your best judgment here; preoxygenate when you can, but your priority is the quick and efficient removal of the aspirate.
A detailed and thorough handoff report may be an overlooked factor in the treatment of aspiration pneumonia. Making sure the oncoming staff is aware of the patient’s actual or potential aspiration may change the course of treatment for the patient and improve their overall outcome.
Quality handoff reports can be a real challenge in the EMS setting. Caring for critically ill or injured patients takes a lot of focus, and the handoff may be an aspect of your care that suffers because you are so focused “in the moment” with the patient or because you are provided very little information on the patient to begin with.
However, even with limited information, a rapid and thorough handoff is attainable. If possible, focus on obtaining and reporting a complete set of vital signs prior to handoff, and develop a standardized approach to patient handoffs to make sure you haven’t missed any details.
Using these treatment guidelines, you will be better prepared the next time you encounter a patient with potential or actual aspiration. Focus on prevention, use additional strategies in positioning and medication precautions, and be sure you always communicate your findings. These will give your patients the best chance for recovering from a potentially life-threatening case of aspiration pneumonia.
Editor's Note: This blog was originally published in April 2019. It has been re-published with additional up to date content.