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Appendix 63.1

  • Aspiration is the misdirection of oropharyngeal or gastric contents into the larynx and lower respiratory tract. Around 45% of healthy people aspirate during sleep. Aspiration is more common in hospital patients, particularly after a stroke or with a reduced conscious level, when the upper airway becomes colonized with Gram-negative bacteria.
  • Conditions that predispose to aspiration pneumonia include:
    • Reduced consciousness, resulting in a compromise of the cough reflex and glottic closure
    • Dysphasia from neurologic deficits
    • Disorders of the upper gastrointestinal tract including oesophageal disease, surgery involving the upper airways or oesophagus, and gastric reflux
    • Mechanical disruption of the glottic closure due to tracheostomy, endotracheal intubation, bronchoscopy, upper GI endoscopy, and nasogastric feeding
    • Protracted vomiting
    • Large volume NG tube feedings
    • Feeding gastrostomy
  • Aspiration pneumonia syndromes and management is summarized in Table 63.2.