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Key Features

  • Pulmonary response depends on the characteristics and amount of gastric contents aspirated

  • One of the most common causes of acute respiratory distress syndrome

  • May be catastrophic

  • Sometimes referred to as Mendelson syndrome

Clinical Findings

  • Abrupt onset of respiratory distress, with cough, wheezing, fever, and tachypnea

  • Crackles may be audible at the bases of the lungs

  • Hypoxemia may be noted immediately after aspiration occurs

  • Fever and leukocytosis are common even in the absence of infection

  • Patchy alveolar opacities in dependent lung zones, appear within a few hours

  • Radiographic features of bronchial obstruction may be observed if particulate food matter has been aspirated along with gastric acid

  • Hypotension secondary to alveolar capillary membrane injury and intravascular volume depletion is common

Diagnosis

  • The more acidic the material, the greater the degree of chemical pneumonitis

  • Aspiration of pure gastric acid (pH < 2.5) causes

    • Extensive desquamation of the bronchial epithelium

    • Bronchiolitis

    • Hemorrhage

    • Pulmonary edema

Treatment

  • Supplemental oxygen

  • Measures to maintain airway

  • Management of acute respiratory failure

  • Administer intravenous fluids for intravascular volume depletion

  • No evidence supports routine use of corticosteroids or prophylactic antibiotics

  • Management of secondary pulmonary infection depends on observed flora of tracheobronchial tree

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