History and exam
Key diagnostic factors
common
presence of risk factors
Risk factors for aspiration can be classified according to the underlying mechanism, which can cause acute aspiration due to:
Aspiration of food, drink, oral secretions, or other substances:
Swallowing dysfunction (e.g., stroke, dementia, epilepsy, multiple sclerosis, Parkinson’s disease, motor neuron disease, cardiorespiratory disease, head and neck cancers)
Impaired conscious level
Substance misuse (e.g., acute alcohol intoxication, opioid toxicity)
During general anaesthesia (or other oropharyngeal procedures) or in the intensive care unit. These are common scenarios; the patient may present asymptomatically, or with bronchospasm, hypoxia, cough, dyspnoea, fever, and even respiratory failure from non-cardiogenic pulmonary oedema[11][12]
Gastrointestinal (GI) disease (e.g., upper GI surgery, hiatal hernia), conditions that affect gastric emptying (e.g., obesity, pregnancy), and oesophageal abnormalities (e.g., dysmotility, strictures, fistulas, gastroparesis [which can be due to diabetes])
Poor cough (e.g., upper airway problems such as pharyngeal pouches and vocal cord palsies, neuromuscular disease)
Increased severity of illness
Following upper gastrointestinal studies with barium. Aspiration of barium sulfate can cause aspiration pneumonitis, which can present with respiratory distress
Head and neck trauma. The patient may acutely aspirate blood in this scenario
Reflux/vomiting:
Substance misuse (e.g., acute alcohol intoxication, opioid toxicity)
General anaesthetic or oropharyngeal procedures
Recumbent position during enteral feeding
Polytrauma
Head and neck cancers.
intractable cough
Seen in 36% of patients with aspiration of gastric contents.[42]
fever
Extremely common after aspiration of gastric contents, occurring in 94% of cases.[42]
dyspnoea
Extremely common after aspiration of gastric contents, seen in 78% of cases.[42] In severe cases, respiratory failure may result from non-cardiogenic pulmonary oedema.
wheezing
Occurs in 32% of patients after aspiration of gastric contents.[42]
hypoxia
A feature of acute aspiration, particularly if the patient has aspirated during general anaesthesia or oropharyngeal procedures, or in the intensive care unit.
It is seen more commonly in patients with underlying cardiorespiratory disease, and with more significant aspiration.
crackles
Presence on lung auscultation is common after aspiration of gastric contents, occurring in 72% of cases.[42]
reduced conscious level
An common feature following acute aspiration.
uncommon
cyanosis
An uncommon feature of acute aspiration.
bronchospasm
May be a feature of aspiration during general anaesthesia or oropharyngeal procedures, or in the intensive care unit.
Use of this content is subject to our disclaimer