Pulmonary aspiration is the entry of solid or liquid material such as pharyngeal secretions, food, drink, or stomach contents from the oropharynx or gastrointestinal tract, into the trachea and lungs.

These consequences depend on the volume, chemical composition, particle size, and presence of infectious agents in the aspirated material, and on the underlying health status of the person.

People with significant underlying disease or injury are at greater risk for developing respiratory complications following pulmonary aspiration, especially hospitalized patients, because of certain factors such as depressed level of consciousness and impaired airway defenses (gag reflex and respiratory tract antimicrobial defense system).

[3] Neurologic conditions that affect muscle coordination and posture (such as cerebral palsy, Parkinson's disease, muscular dystrophies, etc.)

), connective tissue diseases, neuropathy, or other central nervous system-related disorders (stroke, head injury, ALS, Guillain-Barre, etc.).

[6] Medications including sedatives, hypnotics, and antipsychotics can result in decreased level of consciousness and loss of cough and swallow reflexes.

Signs and symptoms that aspiration is complicated can include dyspnea (shortness of breath), hypoxemia (low oxygen in the blood), tachycardia (high heart rate), fever, and crackles or wheezes on lung exam.

[12] Chest CT Scan can identify the presence of a pneumonia as well, and can also assist in characterizing abscesses, foreign objects, or pleural disease.

Death from aspiration and aspiration-related syndromes is most common in elderly patients with known baseline risk factors, though it frequently goes unrecognized.

Significant aspiration can only occur if the protective reflexes are absent or severely diminished (in neurological disease, coma, drug overdose, sedation or general anesthesia).

In intensive care, sitting patients upright reduces the risk of pulmonary aspiration and ventilator-associated pneumonia.

[21] In the event that the basic measures do not remove the foreign body, and adequate ventilation cannot be restored, need for treatment by trained personnel becomes necessary.

[21] If non-invasive measures do not dislodge the foreign body, and the patient can maintain adequate ventilation, rigid bronchoscopy under general anesthesia should be performed.

[23] Rigid bronchoscopy allows good airway control, ready bleeding management, better visualization, and ability to manipulate the aspirated object with a variety of forceps.

[23] After the foreign body is removed, patients should receive nebulized beta-adrenergic medication and chest physiotherapy to further protect the airway.

[21] These include situations such as when the foreign body is difficult or impossible to extract, when there is a documented respiratory tract infection, and when swelling within the airway occurs after removal of the object.

[23] These patients should remain under observation in the hospital until successful extraction as this practice can result in dislodgement of the foreign body.

In these cases, glucocorticoids, aerosolized epinephrine, or helium oxygen therapy may be considered as part of the management plan.