Aspiration Event
Background
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Definition: inhalation of gastric contents into the lung via passive regurgitation or active vomiting
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Common patients:
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"Full stomach": Not NPO, bowel obstruction, pregnant, gastroparesis, intoxicated
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Incompetent LES: hiatal hernia, previous esophageal/gastric surgery, obese
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Can't protect airway: ↓ LOC, residual NMB, neurologic disease
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Considerations
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Signs/symptoms: Severe hypoxemia, ↑ peak insp. pressure, bronchospasm, ↑ tracheal/oropharyngeal secretions, chest retractions, dyspnea, coughing, laryngospasm, pulmonary edema
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↑ morbidity/mortality: pneumonia, ARDS, sepsis, barotrauma
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CXR: infiltrates and atelectasis, but can be unremarkable
Prevention
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Avoid GA & excessive sedation if possible
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Consider awake intubation
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Ensure NPO status, if elective
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Medications prior to induction:
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Non-particulate antacide: Sodium citrate PO
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H2 Antagonists: Ranitidine IV
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Metoclopramide IV
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Suction through NGT before inducing
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Remove NGT when inducing
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Suction on
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Cricoid pressure
Management
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Suction oropharynx
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Intubate & inflate cuff
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Suction through ETT
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PPV with 100% and adequate PEEP
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Bronchoscopy to:
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Assess level of contamination
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Remove particulate matter
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Cancel elective surgery & minimize emergency surgery
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Supportive care
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Crystalloids better than colloid, H2 blockers, intermittent pulmonary toilet
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Consider antibiotics
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Consider ECMO if unable to oxygenate
References
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Gaba, D. M. (2015). Aspiration of Gastric Contents. In Crisis management in anesthesiology. essay, Elsevier Saunders.