Pulmonary Aspiration: An Overview

Pulmonary aspiration presents a serious risk to the elderly and infirm, patients experiencing medical emergencies, intubated patients, and anyone undergoing medical or dental procedures. The right suction unit is the most powerful weapon in the fight against aspiration. Ideally, it can prevent aspiration altogether by maintaining a patent airway. Mortality and morbidity associated with pulmonary aspiration are high, with the most common consequence being aspiration pneumonia. One study suggested the 30-day mortality rate for aspiration pneumonia was 21 percent. Understanding this potentially lethal syndrome is key to preventing and treating it.

Pulmonary Aspiration Risk Factors

Not all patients are at equal risk of aspiration. The most significant risk factors include:

• Mobility impairments that make it difficult or impossible to sit up straight.
• Dementia and other neurological impairments that can impede the ability to swallow or make sound decisions.
• Advanced age. The elderly are more likely to aspirate and significantly more likely to die of aspiration. A study of aspiration patients ranging in age from 13-95 years old found a median age at death of 72 years.
• General anesthesia. Aspiration under general anesthesia remains rare, especially with today’s anesthesia techniques. But without proper airway monitoring, aspiration can occur. Though popular wisdom suggests that eating before surgery increases the risk, a 2009 study found that other risk factors, such as gastroesophageal reflux disease (GERD) and dysphagia, were more frequently tied to aspiration.
• Airway problems, such as vocal cord immobility or oropharyngeal deformities.
• Endotracheal intubation. Long-term intubation appears to increase the risk.
• Respiratory infections and inflammation.

Recent research suggests that aspiration is common and that healthy patients can deal with small volumes of aspirate, as well as the minimal pathogens to which this aspiration exposes them. Aspiration that causes additional symptoms should be viewed as a syndrome caused by unusually large aspirate volume, a weakened immune system, or exposure to large quantities of dangerous microbes.

Causes of Morbidity and Mortality in Pulmonary Aspiration

The primary causes of morbidity and mortality in pulmonary aspiration are:

• Asphyxiation: This can cause death in minutes, and is more common in patients with respiratory compromise who are continuously vomiting or bleeding.
• Chemical pneumonitis: Sometimes called chemical pneumonia, this side effect is most prevalent in people who aspirate acidic substances that damage the airway.
• Aspiration pneumonitis: This airway inflammation due to aspiration is often complicated by the aspiration of pathogens.

Because people who aspirate are often already ill, they are more vulnerable to the consequences of bacteria—especially gram-negative pathogens—in the aspirated fluid. Even when suction is prompt and effective, a patient must be monitored for signs of inflammation, infection, and airway damage.

Symptoms and Signs

Pulmonary aspiration is not always immediately apparent, so it’s important to monitor at-risk patients for early signs. Patients who have aspirated under general anesthesia may show sudden drops in oxygen saturation. Conscious patients may have a gurgling cough, complain of shortness of breath, have foul breath, or cough up dark sputum. When aspiration is suspected, treat a patient as if they have aspirated until further testing can verify or rule out aspiration.

Treating and Preventing Pulmonary Aspiration

Suctioning and protecting the airway of surgical patients is the most effective preventative for pulmonary aspiration. In patients with dentures or other dental structures, it’s critical to monitor the airway to ensure that broken teeth or other objects don’t compromise the airway or increase the risk of aspiration.

In patients who are actively aspirating or who cannot clear their own airways, prompt suctioning can reduce mortality and morbidity. In patients who are continually vomiting or whose airway is contaminated with blood, continuous suctioning via the SALAD technique improves outcomes.

Patients who have aspirated need to be evaluated and are often put on broad-spectrum antibiotics. Depending on patient health and response to antibiotics, it may be necessary to take a culture to determine which pathogens have infected the airway.

Treating aspiration demands preparation and skill. Your team must train with patients in a variety of settings. The right equipment is critical. A portable suction device offers more flexible options for aspirated patients, and can save lives—but only if the suction is adequate and the battery life is long. For help selecting the right portable suction device for your agency, download our free guide, The Ultimate Guide to Purchasing a Portable Emergency Suction Device.