Aspiration syndromes-1 Year 4 Paediatrics Notes OmpathStudy

Aspiration syndromes-1 Year 4 · Paediatrics Collection: 4TH YEAR ALL NOTES / PAEDS / PAEDS 4.1 / Agisa -- Slide 1 Aspiration syndromes Dr agisa kegode Mbchb Slide 2 Definition Defined as the passage of material from the oropharynx into the tracheobronchial tree Slide 3 Spectrum ranges from asymptomatic condition to acute life threatening events. Aspiration can be from above or from below Aspiration can be from:gastric content,foreign bodies,hydrocarbon products, excessive secretions CHAMP-camphor,halogenated carbons,aromatic hydrocarbons and those associated with metals and pesticides-these agents can easily be aspirated Slide 4 Predisposing factors 1- anatomical and mechanical factors-tracheoesophageal fistula,cleft palate 2. neuromuscular-altered consciousness, cerebral palsy 3. GERD 4. miscellaneous—poor feeding techniques, poor oral hygiene Slide 5 Risk factors CNS disorders\nIntoxication or drug overdose\nSeizure disorders Recent anesthesia\nSwallowing disorders\nPoor oral care\nGastroesophageal reflux Esophageal diverticula, such as Zenker’s Cleft palate Slide 6 location The location is often gravity dependent, and depends on the person's position.\nGenerally, the right middle and lower lung lobes are the most common sites affected, due to the larger caliber and more vertical orientation of the right main stem bronchus.\nPeople who aspirate while standing can have bilateral lower lung lobe infiltrates.\nThe right upper lobe is a common area of consolidation, where liquids accumulate in a particular region of the lung, in alcoholics who aspirate in the supine position. Slide 9 Location Aspiration, no matter what the type, usually occurs in the gravity dependent portions of the lung Lower lobes, especially right-sided, including and especially the superior segments of the lower lobes\nBecause of the larger caliber and straighter course of the right main bronchus\nPosterior segments of the upper lobes Aspiration which occurs while the person is prone may be seen in the right upper lobe and middle lobe or the lingula Slide 10 Location-segments The posterior segment of the upper lobes and the superior segment of the lower lobes are most commonly involved lung sites when aspiration occurs in a recumbent patient.\nIn an erect patient, aspiration is more likely to involve bilateral basal segments, middle lobe, and lingula Slide 11 Gastric content aspiration Large volumes of aspiration can occur after vomiting.. Can be a complication of gastroenteritis,altered level of consciousness,general anesthesia Pathophysiology depends on –PH and volume of aspirate, and amount of particulate material and duration of aspiration Severity is associated with volumes 0.8mls/kg and PH <2.5 Most clinical changes are present within 1-2 hours after aspiration Massive aspiration can result in hypoxaemia,haemorrhagic pneumonitis,atelectasis and intravascular fluid shifts Slide 12 treatment Perform immediate suctioning of the airway, Later suctioning and bronchoscopy can be done if large particulate matter was aspirated Monitor oximetry,blood gas analysis and chest xray Recovery will be in 2-3 weeks unless complications occur e.g infections or barotrauma Cover for infection s if predisposing factors present,if purely chemical pneumonitis then antibiotics might not be necessary initially. Prevention-feeding with enteral tubes passed beyond the pylorus,elevating head of bed NPO for atleast 4 hours pre op before general anaesthesia Slide 13 hydrocarbons Include turpentine,gasoline,kerosene Symptoms occur within 30 minutes. Can present with severe pneumonitis. Lung changes occur within 2-8 hours and peak 48-72 hours Persistent pulmonary function abnormalities can be present many years after aspiration of hydrocarbons Other organs e.g the liver,cns,and heart can also be affected Slide 14 treatment Gastric emptying is nearly always contraindicated because of the risk of aspiration Treatment is generally supportive with oxygen,fluids, and ventilator support if required Patients who ingest volumes 30 mls can benefit from gastric emptying Treatment should be considered individually Slide 15 Chronic recurrent aspiration Recurrent aspiration of small quantities of gastric,nasal or oral contents can lead to several clinical presentations These include-bronchiolitis,recurrent pneumonia,atelectasis,wheezing,cough,apnea, and laryngospasms Predisposing factors include1- anatomical and mechanical factors-tracheoesophageal fistula,cleft palate,GERD 2. neuromuscular-altered consciousness, cerebral palsy 3. miscellaneous—poor feeding techniques, poor oral hygiene Slide 16 Chronic aspiration Zenker’s diverticulum\nAchalasia\nTE fistula\nNeuromuscular diseases Chronic reflux\nLipoid pneumonia Mineral oil (used as a laxative)\nOily nose drops (not used anymore) Slide 17 diagnosis Assess feeding Look for predisposing factors Drooling, or excessive accumulation of saliva in the mouth suggests dysphagia Upper GI studies like barium swallow with video fluoros