Victoria Aramă *, Athena Negoiță **, Raluca Sandu **
* Dr. Victoria Aramă – Medic primar, Institutul de Boli Infecțioase “Prof. Dr. Matei Balș” București; Șef de Lucrări, UMF “Carol Davila” București. Doctor în Științe Medicale
** Dr. Athena Negoiță, Dr. Raluca Sandu – Medic rezident Boli Infecțioase, Institutul de Boli Infecțioase “Prof. Dr. Matei Balș”, București
Abstract
Aspiration pneumonia ( AP) results from the inhalation of naso- and oropharyngeal endogen secretions or exogen substances into the lower respiratory tract, in the presence of some risk factors. AP represents a significant percentage of the community-acquired and nosocomial pneumonia, being caused by both aerob and anaerob germs. There are three types of AP depending on the nature of the aspirated material, on the clinical syndrome and the management: aspiration pneumonitis, pneumonia by aspiration of fluid or solid matters (mechanical obstruction of the airways followed by bacterial suprainfection) and pneumonia by aspiration of naso – and oropharyngeal endogen secretions. Chest radiography shows especially lesions situated in the declive pulmonary segments. The management of AP is complex: antibiotic therapy, positive pressure mechanical ventilation, tracheal suction, oxygenotherapy + isoproterenol, foreign body extraction, intravenous hydration, etc. Th e american medical school recommends as antibiotic of first choice in AP clindamycin and the trench school recommends amoxicillin/clavulanate. The prophilaxy of AP, which overlaps for the most part with that of the nosocomial pneumonia, has a major role. It comprises, according to the American Thoracic Society, the following measures: semirecumbent positioning of patients, hand washing and use of protective gowns and gloves when medical staff comes in contact with the patient. Administrating sucralfate instead of antiacids in order to preserve the acid gastric barrier is a controversial strategy. Continuous subglottic suctioning in patients receiving mechanically assisted ventilation is still under evaluation.There are a few contraindicated measures to prevent AP: selective decontamination of the digestive tract and local antibioticotherapy.