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Reducing the Risk of Aspiration Pneumonitis

Regurgitation of gastric contents with subsequent aspiration into the lungs contributes significantly to morbidity and mortality in surgical and nonsurgical patients. The consequences of aspiration pneumonitis depend on the volume and the acidity of the aspirate, and the presence of particulate and bacteria in the aspirate. The occurrence of aspiration pneumonitis may be prevented by correction of risk factors, careful monitoring, and appropriate airway management. The goal of aspiration pneumonitis prophylaxis is to minimize pulmonary complications by controlling risk factors for gastric regurgitation, which include gastric pH ≤ 2.5, gastric volume >25 mL, lower esophageal sphincter incompetence, and delayed peristalsis. Prophylactic techniques include nasogastric decompression, acid neutralization, acid suppression, and increased gastric peristalsis. The ability of drugs to alter risk factors does not guarantee that aspiration will not occur, but it does reduce the likelihood of secondary respiratory complications. The ideal prophylactic agent should consistently reduce all risk factors, produce a prompt and sustained response, and possess few adverse effects and drug interactions.