Aspiration (medicine)
| Classification according to ICD-10 | |
|---|---|
| P24.- | Aspiration syndromes in the newborn |
| T17.- | Foreign bodies in the airways |
| ICD-10 online (WHO version 2019) | |
With aspiration (Latin: aspirātiō from aspirare , suck ', from ad , zoom' and spirare breathe ') is referred to in medicine the penetration of material (saliva / liquid / food / Refluat / contrast agent) in the respiratory tract below the Glottis level with insufficient protective reflexes (e.g. cough reflex ). Colloquially it is referred to as "getting something down the wrong throat" or "choking it up". Sucking in liquids or the like, for example with a syringe , is also called aspiration.
Foreign body aspiration
A foreign body aspiration shows up when the patient can suddenly no longer breathe, speak or cough. Foreign body aspiration is most common in children. Mainly affected are older babies and toddlers aged one to four years due to their general tendency to put objects in their mouths or to eat something that has a smooth surface in a restless situation. The foreign bodies most commonly aspirated by children are peanuts, but also candy or small toy parts. Boys are overrepresented with up to 65%. Aspirations of foreign bodies also occur in adults, for example if someone holds nails or screws with their mouth while doing manual work, then gets frightened and suddenly inhales heavily.
With acute aspiration of a foreign body and its early removal by means of bronchoscopy and optically guided forceps, there are hardly any inflammatory reactions afterwards. However, it is different with aspirations that are not treated for a long time: Here, treatment with antibiotics is often necessary before the foreign body is removed . After a while, strong reactions of the bronchial system can occur, especially when aspirating spicy or salted food. Here, in addition to treatment with antibiotics, anti-inflammatory therapy must be carried out.
The aspiration of a foreign body is also known as bolus aspiration . If the airway is completely obstructed by a stuck foreign body, there is an emergency that may require immediate action such as the Heimlich maneuver or blows with the flat of the hand between the shoulder blades in the head-upper body position.
Aspiration of saliva / food / stomach contents / vomit
A swallowing disorder can result in aspiration of material (saliva, fluid, food, reflux, contrast agent). If there is relevant aspiration of saliva in addition to the aspiration of food and liquids, a tracheotomy with the insertion of a blocked tracheostomy tube must be considered. In general, the risk of aspiration is increased if the consciousness is disturbed, e.g. B. in intoxication by alcohol, drugs or medication, in disorders of consciousness by z. B. diabetic coma , syncope, for example in cardiac arrhythmias , seizures, traumatic brain injury, etc.
Causes of aspirations in the newborn may have a tracheoesophageal fistula , an incomplete closing of the epiglottis or Larynxspalt ( English Laryngeal cleft be).
If you vomit while lying on your back or on your side, or if you have insufficient protective reflexes (swallowing, coughing), there is a risk of aspiration, especially the risk of aspiration of acidic stomach contents.
Those present should be alert if a person experiences a sudden coughing attack that may or may not be accompanied by shortness of breath . A radiological examination using a chest X-ray overview, a chest X-ray in exhalation or fluoroscopy are the first diagnostic measures. Scintigraphy is another option. The Krypton 81 m ventilation scintigraphy has a particularly high detection rate. Ultimately, a bronchoscopy should not only provide diagnostic clarification, but also therapeutic success.
Complications
- Aspiration can be remedied by the body by coughing out the aspirated substance or the foreign body itself ("swallowing").
- If a foreign body remains in the airways, it can be dangerous. The most important and most fatal complication - especially in children, because the airways are still small - is suffocation. For example, if a child has a bean in the airways, the moisture there can cause it to swell up and swell, so that it eventually obstructs the entire windpipe . The child would then suffocate.
- If the foreign body or the aspirate remains in the lungs, this can lead to pneumonia . This inflammation can be caused by chemical stimuli (from stomach acid) or an infection. If the aspirate is not removed, recurrent pneumonia ( aspiration pneumonia ), atelectasis , granulations and stenosis up to and including lung failure (ARDS) can result.
When aspirating water, it is probably irrelevant for the extent of the cardiopulmonary effects whether salt or fresh water was aspirated.
Recurrent aspirations
Chronic aspiration is understood as the repeated penetration of foreign secretions such as gastric juice into the airways, which can especially occur in consciousness-impaired or neurological patients. If this is not noticed by caregivers or relatives, it is called “silent aspiration”. In some cases, this form of aspiration can be demonstrated by detecting fat deposits in alveolar macrophages, which can be obtained using BAL .
If aspiration or aspiration pneumonia recurs, swallowing therapy by a speech therapist or occupational therapist may be indicated.
Aspiration prophylaxis
Aspiration prophylaxis means precautionary measures that reduce the risk of aspiration. Before operations that can be planned , these include, among other things, six to eight hours of food and fluid abstinence , the insertion of a nasogastric tube for interventions on non-fasting patients and the administration of an antacid before the operation.
In patients with a risk of aspiration, the upper body is raised up for food intake while eating and drinking and enough time is allowed to eat and drink. After eating, the upper body remains elevated for some time and any leftover food is thoroughly removed from the mouth and throat. Under certain circumstances, a suction device must be available in order to be able to remove secretions from the patient's mouth before eating and to suck off any food residues after eating.
literature
- Hilmar Burchardi: Etiology and pathophysiology of acute respiratory failure (ARI). In: J. Kilian, H. Benzer, FW Ahnefeld (ed.): Basic principles of ventilation. Springer, Berlin a. a. 1991, ISBN 3-540-53078-9 , 2nd, unchanged edition, ibid. 1994, ISBN 3-540-57904-4 , pp. 47-91; here: pp. 78–80.
- G. Smith, A. Ng: Gastric reflux and pulmonary aspiration in anaesthesia. In: Minerva Anestesiol. 2003; 69 (5), pp. 402-406. Review. PMID 12768174
- G. Wildermann: Foreign body aspiration in childhood , Med.Diss. University of Cologne, 1998
Individual evidence
- ↑ Walied Abdulla: Interdisciplinary Intensive Care Medicine. Urban & Fischer, Munich a. a. 1999, ISBN 3-437-41410-0 , p. 5 f. ( Bolus aspiration ).
- ↑ See Jost Kaufmann, Michael Laschat, U. Frick, T. Engelhardt, Frank Wappler: Determining the probability of a foreign body aspiration from history, symptoms and clinical findings in childre. In: British Journal of Anesthesia. Volume 118, 2017, p. 626 f.
- ↑ T. Nicolai, K. Reiter: Emergency therapy for acute foreign body aspiration in children. In: Emergency & Rescue Medicine. 2004, 7, pp. 501-506.
- ↑ Walied Abdulla: Interdisciplinary Intensive Care Medicine. 1999, p. 5.
- ↑ Guidelines for Diagnostics and Therapy in Neurology, Neurogenic Dysphagia, 2008.
- ↑ JP Orlowski, MM Abulleil, JM Phillips: The hemodynamic and cardiovascular effects of near-drowning in hypotonic, isotonic, or hypertonic solutions . In: Annals of emergency medicine . tape 18 , no. 10 , October 1989, p. 1044-1049 , PMID 2802278 .
