Aspiration pneumonia
The content of the article:
- Causes and risk factors
- Disease stages
- Symptoms
- Features of the course of aspiration pneumonia in newborns
- Diagnostics
- Treatment
- Possible complications and consequences
- Forecast
- Prevention
Aspiration pneumonia is an acute infectious-toxic inflammatory process in the lung tissue that occurs when the contents of the stomach, nasopharynx or oral cavity enter the lower respiratory tract.
The disease is common. According to statistics, every fourth case of severe infectious lung disease is caused by aspiration pneumonia.
Aspiration pneumonia is an inflammation of the lung tissue
Causes and risk factors
The following conditions can lead to the development of aspiration pneumonia:
- alcohol or drug intoxication;
- general anesthesia;
- traumatic brain injury;
- myasthenia gravis;
- Parkinson's disease;
- multiple sclerosis;
- stroke;
- brain tumors;
- metabolic encephalopathy;
- cerebrovascular disorders;
- epilepsy.
Of no small importance in the pathological mechanism of the development of aspiration pneumonia are diseases that occur with symptoms of regurgitation and (or) dysphagia:
- hernia of the esophageal opening of the diaphragm;
- esophageal stenosis;
- gastroesophageal reflux disease;
- achalasia of the cardia.
Risk factors for developing aspiration pneumonia:
- respiratory tract injuries;
- foreign bodies in the trachea or bronchi;
- endotracheal manipulations, intubation, tracheostomy;
- vomiting.
Aspiration pneumonia often occurs in children in the first years of life. The following factors play a role in its development:
- force-feeding a baby;
- ingress of foreign bodies into the bronchi;
- aspiration of meconium.
In the oral cavity and upper respiratory tract in patients with caries, gingivitis, periodontal disease, tonsillitis, there is a pathogenic microbial flora. Its ingress into the lower respiratory tract with aspiration syndrome can cause infectious inflammation of the lung parenchyma.
The results of microbiological studies show that in almost 50% of cases, aspiration pneumonia is caused by anaerobic microflora (fusobacteria, prevotella, bacterioids). In 10% of cases, the development of an infectious and inflammatory process is based on infection of the lung tissue with aerobic bacteria (Pseudomonas aeruginosa, Escherichia coli, staphylococci, Proteus, Klebsiella). In the remaining 40% of cases, the etiology of the disease is of a polymicrobial combined nature.
According to research, about half of cases of aspiration pneumonia are caused by anaerobic microflora
The ingress of solid particles or liquid aspirate into the lower parts of the respiratory system leads to mechanical obstruction (blockage) of a section of the tracheobronchial tree. Against this background, a cough reflex arises, which contributes to an even deeper penetration of the aspirate. Mechanical obstruction causes the development of atelectasis (a decrease in the lung lobe), stagnation of bronchial secretions, which increases the risk of infection.
The aspirated contents have an aggressive effect on the lung tissue, which leads to the development of acute chemical pneumonitis. With this pathology, a large amount of biologically active substances (cytokines, tumor necrosis factors) are released, which have a damaging effect on the lung parenchyma.
The attachment of a microbial component leads to the appearance of signs of bacterial pneumonia:
- increased body temperature;
- cough;
- general weakness;
- sweating;
- shortness of breath.
Disease stages
The clinic of aspiration pneumonia develops gradually. During the course of the disease, the following stages are distinguished:
- Acute pneumonitis.
- Necrotizing pneumonia.
- Lung abscess.
- Empyema of the pleura.
Symptoms
The clinical picture of aspiration pneumonia in the initial stage is erased. After an episode of aspiration, patients may experience a dry, unproductive cough, general weakness, and a slight increase in body temperature for several days. Then these symptoms are joined by:
- chest pain;
- tachycardia;
- dyspnea;
- cyanosis.
The body temperature rises to 38-39 ° C, and the cough begins to be accompanied by the release of foamy sputum, in which an admixture of blood can be found.
With aspiration pneumonia, the temperature rises and a cough appears with the release of foamy sputum
After 10-14 days from the onset of the disease, an abscess forms in the lung and pleural empyema occurs. Clinically named processes are accompanied by the appearance of:
- strong cough with profuse discharge of purulent sputum, often with a putrid odor;
- an increase in body temperature to 40-41 ° C, accompanied by tremendous chills.
Features of the course of aspiration pneumonia in newborns
Causes of aspiration pneumonia in newborns:
- aspiration of meconium in post-term pregnancy;
- birth injury;
- immaturity of lung tissue in premature babies;
- intrauterine infection.
Almost all children with aspiration pneumonia are born to mothers with a burdened obstetric history:
- with chronic fetal hypoxia;
- with a long anhydrous interval;
- with a complicated course of childbirth.
In addition to general signs of respiratory failure, with aspiration pneumonia of newborns, other symptoms come to light:
- pale gray skin color;
- hypo- or areflexia;
- frequent regurgitation;
- vomiting;
- intestinal paresis;
- loss of body weight by more than 30% and a very slow weight gain.
Diagnostics
It is possible to assume the presence of aspiration pneumonia in the patient by the presence of an indication of the fact of aspiration in the anamnesis. The diagnosis is confirmed by the data of physical, microbiological, endoscopic and X-ray studies.
X-ray aspiration pneumonia
Treatment
If foreign bodies enter the airways with the development of obstruction, they are endoscopically removed with mandatory oxygen therapy. In severe cases, it may be necessary to intubate the trachea and transfer the patient to mechanical ventilation.
Therapy of aspiration pneumonia must necessarily include the appointment of antibiotics, taking into account the sensitivity of the bacterial microflora to them. The simultaneous use of several antibacterial drugs is justified. The duration of the course of antibiotic therapy is at least 14 days.
When an abscess forms, it is drained. To improve the discharge of purulent sputum, the patient is given percussion or vibration massage of the chest several times a day. They also carry out sanitation bronchoscopy to remove purulent secretions, bronchoalveolar lavage.
Indications for surgery:
- lung abscess with a diameter of over 6 cm;
- formation of a bronchopleural fistula;
- pulmonary bleeding.
If aspiration pneumonia is complicated by pleural empyema, the pleural cavity is drained and sanitized. If necessary, antibacterial drugs and fibrinolytics can be administered through the drainage into the pleural cavity.
Possible complications and consequences
Aspiration pneumonia can be complicated by the development of:
- empyema of the pleura;
- severe respiratory failure;
- the formation of bronchopulmonary fistulas;
- sepsis.
Aspiration pneumonia can lead to the development of pleural empyema
Forecast
With timely initiation of treatment, a small volume of aspirate and a good initial general condition, the prognosis is favorable. It worsens significantly with the addition of complications. The mortality rate of complicated forms of the disease ranges from 20 to 25%.
Prevention
Prevention of aspiration pneumonia should be aimed at the active treatment of diseases that contribute to its occurrence.
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Elena Minkina Doctor anesthesiologist-resuscitator About the author
Education: graduated from the Tashkent State Medical Institute, specializing in general medicine in 1991. Repeatedly passed refresher courses.
Work experience: anesthesiologist-resuscitator of the city maternity complex, resuscitator of the hemodialysis department.
The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!
