Pulmonary aspiration: an update

Area of Science:

• Pulmonary Medicine
• Critical Care
• Gastroenterology

Background:

• Pulmonary aspiration of foreign material is a common clinical event with significant morbidity and mortality.
• Massive aspiration of gastric contents presents a particularly lethal challenge.
• Physician understanding and management strategies for pulmonary aspiration require clarification.

Purpose of the Study:

• To review the current understanding and treatment of pulmonary aspiration.
• To evaluate the efficacy of corticosteroids and the role of antimicrobial agents.
• To highlight advances in mechanical ventilation and emphasize preventative measures.

Main Methods:

• Review of existing literature on pulmonary aspiration.
• Analysis of treatment modalities including corticosteroids, antimicrobials, and mechanical ventilation.
• Discussion of the bacteriology of aspiration and preventative strategies.

Main Results:

• Current data do not support the use of corticosteroids in treating pulmonary aspiration.
• Understanding aspiration bacteriology has led to more appropriate antimicrobial use.
• Positive end-expiratory pressure (PEEP) is a significant advancement in managing aspiration via mechanical ventilation.

Conclusions:

• Corticosteroids are not recommended for pulmonary aspiration.
• Antimicrobial therapy should be guided by knowledge of causative bacteria.
• Positive end-expiratory pressure is a valuable adjunct in mechanical ventilation for aspiration.
• Pulmonary aspiration in hospitalized patients is preventable through physician awareness and vigilance.