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.