The triple threat of aspiration pneumonia

Aspiration pneumonia is a disease recognized since antiquity. An approach to understanding the clinical setting is to study all patients diagnosed as having aspiration pneumonia. In these reports, the principal underlying conditions are alcoholism, seizure disorders, cerebrovascular accidents, drug addiction, general anesthesia, esophageal disease and nasogastric tube feeding. Certain fluids are toxic to the lower respiratory tract and can initiate an inflammatory reaction which is independent of bacterial infection. Examples include acids, animal fats, mineral oil, alcohol and hydrocarbons. Of these, gastric acid is the most frequently encountered and the most completely studied. Experimental animal studies have shown that toxic effects of acid are immediate and extensive. The most important facet of treating Mendelson's syndrome is to correct hypoxia by vigorous and immediate assisted ventilation or positive pressure oxygen. Repeated tracheal suction is often necessary to maintain a clear airway. Intravenous fluid support is also important, particularly when there is hypotension.