Epidemiology

Aspiration pneumonia is an infectious inflammatory condition that results from the inhalation of oral contents into the lungs. The oral contents can be food, vomitus, inedible objects (e.g., toys, screws, etc.), or oral secretions. One of the earliest recorded aspiration deaths was in 475 B.C. when the Greek poet Anacreon died as a result of aspirating a grape seed.1 Mendelson in 1946, described 66 obstetrical patients who developed respiratory failure as a result of aspiration of stomach contents during obstetric anesthesia.2 The pulmonary effects of aspiration are due to the presence of foreign bodies, chemical irritants, and bacterial pathogens in the material aspirated.3

The true incidence of pathologic aspiration into the lungs is difficult to determine. Small volumes of aspiration that do not lead to infection or pulmonary disease have been documented in approximately 50 percent of normal subjects during sleep.4

Such chronic debilitating conditions as stroke, dysphagia, tube feeding, and altered mental status with decreased level of consciousness place patients at increased risk for aspiration (Tabie „60-1). Of patients studied within 5 days after an acute stroke, 38 percent demonstrated evidence of aspiration.5 One-third of those who aspirated had silent aspiration without evidence of cough or gag. Risk factors and predictors for silent aspiration included dysphagia, dysarthria, voice change after swallow, and abnormal gag reflex (Tabie.„§0:2,).

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