PULMONARY ASPIRATION OF GASTRIC CONTENTS

Abstract

A retrospective analysis of 50 patients who had aspirated gastric contents was performed to define better the course of patients with this syndrome. The patients invariably had a disturbance of consciousness, most commonly due to sedative drug overdose or general anesthesia. The onset of clinical signs occurred promptly after aspiration and tended to be similar in all patients, irrespective of their subsequent course or outcome. These findings usually included fever, tachypnea, diffuse rates and serious hypoxemia. Cough, cyanosis, wheezing and apnea were each seen in approximately 1/3 of the cases. Apnea, shock and early, severe hypoxemia were particularly ominous events. Initial roentgenograms revealed diffuse or localized alveolar infiltrates, which progressed during the next 24-36 h. Subsequent clinical courses followed 3 patterns: 12% of the patients died shortly after aspiration; 62% had rapid clinical and radiologic improvement, with clearing, on average, within 4.5 days; 26% demonstrated rapid improvement but then had clinical and radiographic progression associated with recovery of bacterial pathogens from the sputum and a fatal outcome in more than 60%. Treatment from the outset by adrenocortical steroids or antimicrobial agents had no demonstrable effect on the outcome. The clinical features of aspiration of gastric contents are characteristic and distinguish it from other forms of aspiration-related lung disease.