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Acute effects of sucralfate aspiration: clinical and laboratory observations
K E Shepherd1, C S Faulkner, J C Leiter
1Department of Anesthesia, Massachusetts General Hospital, Boston 02114.
Study Objective:
To assess the complications associated with the aspiration of sucralfate.
Design:
Clinical (case report) and bench observations.
Setting:
Inpatient intensive care unit and experimental animal laboratory.
Subjects:
The case of a critically ill patient who aspirated sucralfate is presented. Fifteen Sprague-Dawley rats served as experimental animals to investigate the acute histologic effects of large-volume aspiration of sucralfate.
Interventions:
The patient underwent emergent intubation to relieve acute upper airway obstruction. All the animals were anesthetized and had tracheostomies performed. The experimental groups had acidic intratracheal injections of 2 ml/kg of a nonparticulate liquid (pH, 2.3; n = 6) or a sucralfate aspirate (1 ml/kg of a 5% sucralfate suspension of pH 3.6, followed by 1 ml/kg 0.1 of normal hydrochloric acid of pH 1.0; n = 4). Four hours after simulated aspiration, the rats were sacrificed and their lungs removed for histologic examination by light microscopy.
Measurements And Main Results:
Differences were noted in histopathologic injury in the experimental groups compared to the control group using a numeric scoring scale. Nonparticulate acidic liquid aspiration caused a significant increase (p < 0.05) in inflammation. Sucralfate caused a significant increase (p < 0.05) in lung hemorrhage. A nonsignificant trend was seen with simulated sucralfate aspiration for edema and inflammation. No long-term sequelae were attributed to the clinical aspiration episode.
Conclusions:
Acute complications associated with aspiration of sucralfate have been identified. In the laboratory setting, simulated aspiration of sucralfate led to acute lung injury.