What is the management for aspiration of liquids causing cough and shortness of breath?

From the Guidelines

Management for aspiration of liquids causing cough and shortness of breath primarily involves supportive care and close monitoring for complications, with a focus on preventing further aspiration through proper positioning, thickened liquids, and swallowing therapy, as highlighted in a recent study 1. The initial approach should include positioning the patient upright and encouraging them to cough to clear the airway. Supplemental oxygen should be provided if oxygen saturation is low. For mild cases without respiratory distress, observation may be sufficient. Key considerations in management include:

• Assessing the risk of aspiration pneumonia, which can be informed by factors such as previous aspiration pneumonia, impaired laryngeal sensation, and poor performance status, as noted in a study on risk factors for aspiration pneumonia 1.
• Obtaining a chest X-ray if symptoms persist or worsen to assess for aspiration pneumonia.
• The use of antibiotics is not routinely recommended unless pneumonia develops, typically 24-48 hours after aspiration, at which point broad-spectrum antibiotics may be prescribed.
• Bronchodilators such as albuterol can help with bronchospasm.
• Severe cases may require intensive care monitoring, mechanical ventilation, or bronchoscopy to clear large obstructions. It's also important to consider the severity of aspiration pneumonitis, which depends on the volume, pH, and bacterial content of the aspirated material, with acidic or contaminated fluids causing more significant inflammation and potential infection. Given the potential for significant morbidity and mortality associated with aspiration pneumonia, a proactive and supportive approach to management, emphasizing prevention of further aspiration and close monitoring for complications, is crucial 1.

From the Research

Management of Aspiration of Liquids

Aspiration of liquids can cause cough and shortness of breath, and its management is crucial to prevent further complications. The following are some key points to consider:

• The diagnosis of aspiration can be made from characteristic clinical features, and management is based on the measurement of pH of gastric contents, blood gases, and acid-base values 2.
• Treatment should include head down in right lateral position to drain vomit from airway, suction, laryngoscopy to clear the airway, and bronchoscophy if asphyxiated by solid material 2.
• Endotracheal intubation may be necessary if liquid is aspirated, and high inspired oxygen and artificial ventilation may be required if the PO2 is low 2.
• Steroids, such as hydrocortisone or dexamethasone, may be administered to reduce inflammation, and aminophylline may be used to treat bronchospasm 2.
• Plasma or plasma substitute may be given to correct hypotension and hypovolaemia, and acidosis should be corrected 2.

Risk Factors for Aspiration

Certain factors can increase the risk of aspiration, including:

• Loss of anatomical integrity of the upper and lower esophageal sphincters 3.
• Increase in the frequency of transient lower esophageal sphincter relaxations 3.
• Desensitization of the pharyngoglottal adduction reflex 3.
• Presence of a nasogastric feeding tube, which can lead to colonization and aspiration of pharyngeal secretions and gastric contents 3.
• History of alcohol abuse, which can increase the risk of aspiration and aspiration pneumonia 4.

Outcomes of Aspiration

Aspiration can lead to serious complications, including:

• Acute respiratory distress syndrome (ARDS) 4.
• Moderate to severe ARDS 4.
• Increased morbidity and mortality 4.
• Requirement for mechanical ventilation 4.
• Increased risk of in-hospital death 4.