Friday, December 20, 2019

Aspiration Pneumonia and unusual interventions

Q: Mention two unconventional interventions that have shown benefit in acute aspiration pneumonia?

Answer: Mechanical ventilation is the most conventional modality to sustain lung function during acute aspiration pneumonia. The oxygenation and protection of airway are directly supplemented by positive pressure effects on lung parenchyma. Some clinicians apply a short course of steroids to mitigate the effects of chemical burn/inflammation. Two other very unusual interventions in this scenario which are not well known but have shown benefits are 
  • Intravenous high molecular weight colloids, and 
  • Sodium nitroprusside infusion into the pulmonary artery
By increasing colloid pressure in alveolar vessels and the supply of blood via vasodilation, the effects of direct effects from acute aspiration on alveoli can be minimized. The data is almost 4 decades old and requires reproducibility. At this juncture,  it may only be of academic interest for clinicians.



1. Broe PJ, Toung TJ, Permutt S, Cameron JL. Aspiration pneumonia: treatment with pulmonary vasodilators. Surgery 1983; 94:95. 

2. Peitzman AB, Shires GT 3rd, Illner H, Shires GT. Pulmonary acid injury: effects of positive end-expiratory pressure and crystalloid vs colloid fluid resuscitation. Arch Surg 1982; 117:662. 

3. Toung TJ, Cameron JL, Kimura T, Permutt S. Aspiration pneumonia: treatment with osmotically active agents. Surgery 1981; 89:588.

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