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[Tracheo-bronchial aspiration of foreign material by the unconscious patient (author's transl)]
Abstract:
180 cases of head trauma were classified according to the degree of impairment of consciousness, clinical and neurological symptoms and EEG patterns. Based on the radiological and clinical findings and blood gas analyses a study was made of the incidence and extent of aspiration of blood, vomit or debris into the tracheo-bronchial tree and of the resultant pulmonary complications. As loss of consciousness became more complete the incidence of aspiration and the amount of material inhaled increased. Clinically and radiologically proven aspiration occurred in 60 per cent of cases of severe head trauma. A comparison of two groups after they had been given first aid and artificial respiration showed that the paO2 values were significantly lower in patients with radiologically proven aspiration and infiltration of the lungs than they were in those with normal chest radiograms. These observations point to the relationship between the quantity of material inhaled and the extent of intra-pulmonary shunting. There was no difference in the incidence of aspiration between persons who had been intubated and those who had not been intubated prior to admission to hospital. Although in many cases of head trauma aspiration of blood immediately after the accident can not be prevented prompt intubation is the only measure that will mitigate the consequences of aspiration and prevent its recurrence. As the latter is a very real risk in the unconscious person intubation in these cases is a "must". The study also showed that aspiration of foreign material into the tracheobronchial system and the resultant pulmonary complications can be successfully treated even if the head trauma is very severe. In none of the cases studied was death attributable to these causes. Apart from intubation and bronchial toilet artificial respiration with oxygen-enriched gas mixtures has a decisive influence on the course of the aspiration-induced pulmonary complications.