Prevention of aspiration of a gastric juice

Description:

1. Treat the first group of the factors contributing to aspiration of gastric contents: the increase in volume of gastric contents or increase in intragastric pressure observed at obstruction of the gatekeeper or ascites. Factors which allow to be carried out to throwing of contents of a stomach in a throat or provoking this throwing make the second group. Carry hernia of an esophageal opening of a diaphragm, and also introduction of the gastroscope to them. Refer the dysfunctions of a throat coming, for example, at a coma or local anesthesia to the third group of the contributing factors and allowing the movement of liquid gastric contents in a trachea. Prevention has crucial importance; among patients with the confirmed aspiration mortality reaches 50%. Careful patient care from risk group on this complication is important. For example, introduction of the nazogastralny probe not always allows to evacuate effectively gastric contents, but can result in functional insolvency of gastroesophagal connection, and also provoke vomiting during its introduction. At a nosotrophy, being in a semicomatose state, it should give situation "lying on one side" with slightly hung head, and when feeding via the nazogastralny probe the head of the patient should be raised. At disturbance of swallowing or the darkened consciousness sometimes the patient should enter an endotracheal tube with a cuff.

2. Quite often the diagnosis of aspiration is made only by process of elimination, but the medical personnel can sometimes witness vomiting and aspiration at the patient; or bile is found in the form of impurity in a tracheal secret or in the form of spots on a pillow. Aspiration can pose an immediate threat of life of the patient; depending on character and quantity can cause partial or full obstruction of respiratory tracts; symptoms of asphyxia in this case are the convulsive respiratory movements or an apnoea. The crucial role is played by immediate removal of aspirate by all available methods; it is necessary to clean a finger a throat, to hang the patient's head, to suck away aspirate or to carry out a direct laringoskopiya.
3. Other option of a clinical picture is the progressing respiratory depression and hemodynamic instability during the first 24 h. The chemical irritation acid gastric contents, especially if it рН less than 2,5, leads to an inflammation and hypostasis. Often found hypovolemia demands correction in/in administration of liquid. Rattles on an exhalation indicate obstruction of bronchial tubes of small caliber. Treatment consists in introduction of an Euphyllinum in/in and an ortsiprenalina is inhalation. Contradictory data on efficiency of corticosteroids at aspiration do not allow to recommend their broad use; however increase in resistance of respiratory tracts, resistant to other drugs, can be the indication to introduction of steroids.

4. Signs of the continuing disturbance of respiratory function are the tachypnea, tachycardia, a hypoxia at inhalation of air with the high content of oxygen, and also the alternation of a hypercapnia which is often found after aspiration with a hypocapny. During treatment there can be a need of an endotracheal intubation and carrying out IVL.

5. Fever, a leukocytosis and increase in viscosity of a phlegm can be direct reaction to aspiration, even in the absence of an infection. The pulmonary infection develops most often during 2 — 14 days after aspiration. Allow to distinguish an infectious complication an aggravation of symptoms of the patient, detection of the activator in a smear or at a bacteriological research of a phlegm and/or blood, pleural liquid, and also emergence or increase in earlier being available infiltrates on the roentgenogram of a thorax. The choice of an antibiotic depends on the activator found at a bacteriological research and definition of its sensitivity. If necessary an antibioticotherapia is begun before obtaining results so that the appointed drugs were effective concerning extra hospital anaerobic activators, and also worked on activators of hospital aerobic and mephitic gangrenes. Preventively antibiotics are appointed only in case of aspiration of the gastric masses which is obviously containing a large number of pathogenic microorganisms.

6. Even for lack of symptoms of an infection at aspiration of gastric contents observation of the patient has to continue 3 — 4 weeks as sometimes the pulmonary infection can develop more than in 2 weeks after an aspiration episode.