Aspiration

LOWER RESPIRATORY TRACT DISORDERS

TOPIC OUTLINE
(1) Definition Managing Effects of Prolonged Intubation
(2) Risk Factors Prolonged endotracheal intubation or tracheostomy can
(3) Prevention depress the laryngeal and glottic reflexes because of disuse.
 Encouraged to phonate and exercise their laryngeal
DEFINITION muscles.
→ inhalation of foreign material (eg. Oropharyngeal or  Have a speech therapist experienced in swallowing
stomach contents) in the lungs. disorders work with the pt to address swallowing problems.
→ a serious complication that can cause pneumonia and result
in the ff clinical picture: tachycardia, dyspnea, central CLINICAL PRACTICE TO PREVENT ASPIRATION
cyanosis, hypertension, hypotension, and potentially death.  Maintain head-of-bed elevation at an angle of 30-40 degrees
unless contraindicated.
RISK FACTORS  Use sedatives as sparingly as possible.
 Seizure activity  For pts receiving tube feeding, confirm the tip location
 Brain injury feeding tube at 4-hour intervals, assess for gastrointestinal
 ↓ LOC from trauma, drug or alcohol intoxication, excessive residuals (<150 mL before next feeding) to the feedings at
sedation, or general anesthesia 4-hour intervals).
 Flat body positioning  For pts receiving tube feedings, avoid bolus feeding in those
 Stroke high risk for aspiration.
 Swallowing disorders  Consult with primary provider about obtaining a swallowing
 Cardiac arrest evaluation before oral feedings are started for pts who were
recently extubated but were previously intubated or less
PREVENTION than or equal to 2 days.
Prevention is the primary goal when caring for patients at risk  Maintain endotracheal cuff pressures at an appropriate level,
for aspiration. and ensure that secretions are cleared from above the cuff
before it is deflated.
Compensating for Absent Reflexes
 Swallowing assessment is necessary for patients with
known swallowing dysfunction or those recently extubated
following prolonged endotracheal intubation.
 Assessed by a speech therapist.
 Position pt in semi recumbent or upright prior to eating.
 Suggest soft diet & encourage to take small bites.
 Instruct pt to keep the chin tucked and the head turned
with repeated swallowing.
 Straws should not be used.
 If breathing, coughing, gag and glottic reflexes are active,
an oral airway should not be inserted when vomiting.
 Suctioning of oral secretions with catheter should be
performed with minimal pharyngeal stimulation.
 For pts with an endotracheal tube and feeding tube,
endotracheal cuff pressure should be maintained at greater
than 20 cm h20 (but less than 30 cm h20 to minimize
injury) to prevent leakage of secretions from around the cuff
into the lower respiratory tract.
 Hypopharyngeal suctioning is recommended before the
cuff is deflated.

Assessing Feeding Tube Placement

 Feeding tube is positioned correctly in the stomach.
 Small-bore flexible feeding tube or surgically implanted
tube – enteral feeding directly into the duodenum.

Identifying Delayed Stomach Emptying

Full stomach can cause aspiration because of ↑ intragastric or
extragastric pressure.
 Intestinal obstruction
 ↑ gastric secretions in gastroesophageal reflex disease
(GARD)
 ↑ gastric secretions during anxiety, stress, or pain
 Abdominal distention d/t paralytic ileus, ascites,
peritonitis, the use of opioids or sedatives, severe illness,
or vaginal delivery