Aspiration Syndromes - Causes, Symptoms, and Management

What Is Aspiration Syndrome?

Aspiration is inhaling food or any substance into the airway or lungs. It can also occur when fluids from the stomach flow backward into the throat. However, unlike choking, the airway is not completely blocked.

Aspiration syndrome is more common in people who have difficulty swallowing. It could be a temporary condition or lead to more severe disease. Usually, people suffer from dysphagia or difficulty swallowing. Older adults with a history of strokes or people and children with developmental disabilities may aspirate frequently or have swallowing difficulties.

How Is Aspiration Syndrome Classified?

Aspiration syndromes are divided into three categories according to clinical and pathological criteria:

1. Large airway mechanical obstruction caused by foreign bodies.

2. Aspiration pneumonitis.

3. Aspiration pneumonia.

What Causes Aspiration Syndrome?

The cough, gagging, and swallowing reflexes (sensory apparatus) protect the respiratory tract from any substance or foreign body. However, if a foreign body is consumed, it leads to aspiration and causes mechanical obstruction of the trachea and asphyxiation.

What Are the Symptoms of Aspiration?

The common indications and symptoms of foreign body aspiration are as follows:

• Tachypnoea (abnormally rapid breathing).

• Tachycardia (abnormally fast heart rate).

• Difficulty in swallowing.

• Wheezing and coughing while eating or drinking.

• Bloating sensation after eating or drinking.

• A sense of an object stuck in the throat.

• Shortness of breath.

• Cyanosis (bluish skin discoloration due to inadequate oxygenation of the blood).

• Recurring pneumonia.

• Having difficulty chewing.

• Heartburn or chest discomfort.

What Are the Risk Factors for Aspiration Syndrome?

The two factors most often cause aspiration:

1. Lack of protective reflexes when awareness is disrupted.

2. Weak neuromuscular function.

Older adults frequently have altered awareness, resulting in weakened protective airway reflexes. The other factors that affect the sensory apparatus are as follows:

• Dementia (gradual loss of memory).

• Sedative medicines.

• Illegal drugs.

• Alcohol usage.

• Metabolic problems.

• Stroke (attack on the brain due to blockage of blood supply).

• Traumatic brain injury.

• Seizures.

Other variables that increase the risk of aspiration include significant oesophageal illnesses that may lead to dysphagia and raise the risk of aspiration are:

• Collagen vascular disorders.

• Achalasia (the lower esophageal sphincter fails to relax, preventing food from flowing into the stomach).

• Oesophageal dysmotility.

• Hiatal hernia (a condition that causes the stomach to push upward through the diaphragm muscle).

• Gastroesophageal reflux (regurgitation of food from the stomach back to the esophagus).

What Is the Risk of Aspiration Syndrome in Infants and Toddlers?

In this age group, infants and toddlers have exploratory behavior such as placing small objects in their mouths, increasing the risk of an aspiration event. They also have decreased capacity of the sensory apparatus, and if a foreign body is swallowed, it leads to aspiration and causes mechanical obstruction of the trachea and asphyxiation.

Depending on the foreign body's size and the airway width, tracheobronchial aspiration causes airflow obstruction. Food, coins, and toys are the most commonly aspirated objects. Mobile teeth and dental appliances frequently aspirate as foreign bodies in adults with decreased sensorium or craniofacial trauma.

Which Medical Procedures Can Lead To Aspiration Syndrome?

The invasive diagnostic and therapeutic procedures of the esophagus or upper thorax, which are risk factors for aspiration, include the following:

• Laryngeal or oesophageal cancer resection.

• Neck or thoracic radiotherapy.

• Gastric malignancy.

Tracheostomy and endotracheal tubes also cause mechanical disruption of glottic closure. Procedures such as bronchoscopy, upper gastrointestinal endoscopy, and nasogastric tube placement can all result in aspiration.

As a result, these procedures must be conducted under the supervision of skilled doctors. Endotracheal intubation, feeding the patient in the recumbent posture, and gastric and intestinal dysmotility due to critical illness are all risk factors for aspiration.

What Is Aspiration Pneumonitis?

Aspiration pneumonitis is a non-infectious inflammatory reaction to an aspiration that can cause mild to severe respiratory dysfunction but is not treated with antibiotics. It is also known as chemical pneumonitis, an inflammatory response produced by ingesting stomach acid.

It can also be caused by the aspiration of milk products, mineral oils, acids, or fats. The alveolar surface lining of the bronchus is damaged due to the acidic or alkaline substance.

What Is Aspiration Pneumonia?

Aspiration pneumonia is a leading cause of respiratory illness and death in elderly and disabled people. It consists of about 10 % of all community-acquired pneumonia (CAP). On initial presentation of aspiration pneumonia, the chest radiograph may exhibit opacities in the airways of the lungs. These findings further lead to airway consolidation and acute respiratory distress syndrome.

What Is the Treatment for Aspiration Pneumonia?

The treatment of aspiration pneumonia includes an antibiotic coverage of gram-negative bacilli and gram-positive cocci, as both aerobic and anaerobic polymicrobes cause most cases.

Piperacillin-Tazobactam, Penicillins with Metronidazole, Clindamycin, and Imipenem have usually been administered for two to six weeks.

How Can Aspiration Syndrome Be Prevented?

Simple treatments show potential in lowering aspiration occurrences in high-risk people with weak protective airway reflexes, altered consciousness, or decreased neuromuscular function is:

• The incidence of nosocomial pneumonia induced by aspiration is reduced when the head is elevated above 30 to 45 degrees, particularly in critically mechanically ventilated patients. Unless contraindicated, all patients in the hospital with risk factors for aspiration should have the head of their bed elevated.

• Feed the person with reduced swallowing ability using a percutaneous endoscopic gastrostomy tube or an endoscopic jejunostomy tube.

• Use of thickened fluids for drinking and a soft mechanical diet.

• Mechanical suction of subglottic secretions.

• Drug-induced inhibition of gastric acid.

• Reduce the usage of sedatives.

• Use of a postpyloric feeding tube.

What Is the Management of Aspiration Syndrome?

Managing a foreign body aspiration necessitates immediate airway clearing, which may include the Heimlich maneuver or bronchoscopy removal of the foreign material. Complete occlusion of the trachea is fatal. If airway patency is not restored within three to five minutes, the person will suffocate or suffer irreparable ischemic damage to the brain and heart.

• Heimlich Maneuver- The Heimlich maneuver is a simple procedure carried out in the event of partial airway blockage. It is a method of applying a thrust to the person behind to remove the blocking object from the throat. It will also provide more time to move the person to appropriate hospital-based care.

• Bronchoscopy- A fiberoptic or rigid bronchoscope removes the foreign substance from the airway. Flexible bronchoscopy can be performed on a person awake and breathing independently. This procedure is done in a hospital if the blockage is severe. With rigid bronchoscopy and an experienced operator, success rates are more significant. The procedure for rigid bronchoscopy requires general anesthesia.

• Corticosteroids- The role of corticosteroids in reducing airway inflammation is limited, and antibiotics should only be used if the person develops post-obstructive pneumonia.

Imaging investigations, such as plain radiographs and computed tomography, can sometimes, but not constantly, localize the location of the aspirated item.

Conclusion:

Aspiration syndrome is a severe condition that can be fatal. In these circumstances, the person’s present health state must be considered, including long-term prognosis and the dangers, advantages, and alternatives to eating.