الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
 |  | from | 87 |  |  |
| | | from | 87 | | |
Abstract
Aspiration induced lung injury is often under diagnosed in the clinical setting in the care of the critically ill and accounts for a significant proportion of acute pulmonary dysfunction, Moreover, it is recognized as an independent risk factor for subsequent development of pneumonia or acute lung injury or acute respiratory distress syndrome (ALI/ARDS).
Aspiration is a frequently reported event in patients with altered levels of consciousness such as patients undergoing general anesthesia, elderly and nursing home residents, people with gastro-intestinal and esophageal abnormalities , as well as patients with neurologic trauma and neuro-muscular diseases.
Aspiration pneumonitis and aspiration pneumonia are clinically difficult to distinguish. Although there is some degree of overlap, the two aspiration syndromes are separate disease entities with distinguishable pathophysiology.
Aspiration pneumonitis is defined as a condition that shows immediate hypoxemia, fever, tachycardia, and abnormalities on chest radiograph, which is caused by macroaspiration of noxious liquids. The noxious fluids are mostly sterile gastric contents; although they can be also bile or other agents introduced through the stomach.
However, changes in gastric pH can result in an environment where potentially pathogenic organisms become viable. Furthermore, gastric colonization due to gram-negative bacteria can occur in patients under enteral feeding or patients with gastroparesis or small-bowel obstruction, if gastric aspiration occurs under these conditions, lung infection from bacterial load in gastric contents can occur in addition to the acute inflammation due to acid or food particles.
For practical purposes it is difficult to differentiate aspiration pneumonitis from aspiration pneumonia. The indication to perform endotracheal intubation and mechanical ventilation is not different from other clinical scenarios and the antibiotic decisions should be based on local ecology of the ICU.
In aspiration patients current practice views the major role of bronchoscopy is the sampling of the lower respiratory tract. The quantitative bacteriology obtained from the BAL samples can guide definitive therapy and de-escalation of antibiotics and can result in discontinuation of antibiotics if cultures do not show significant bacterial growth.
In the current practice the therapeu