[Skip to Content]
Sign In
Individual Sign In
Create an Account
Institutional Sign In
OpenAthens Shibboleth
[Skip to Content Landing]
Article
August 1971

Cardiorespiratory Studies in Critical IllnessChanges in Aspiration Pneumonitis

Author Affiliations

Montreal
From the University Surgical Clinic and Cardiorespiratory Laboratory, Montreal General Hospital and McGill University, Montreal.

Arch Surg. 1971;103(2):335-340. doi:10.1001/archsurg.1971.01350080251040
Abstract

Cardiorespiratory studies in 18 patients with acid aspiration pneumonitis have been correlated with the clinical course. All patients with pH of gastric aspirate less than 1.75 died. Plasma volume deficits measured were moderate and correlated with the degree of systemic hypotension observed. Cardiac failure did not occur except in patients with severe preexisting heart disease or overtransfusion. Routine use of digitalis and fluid restriction is unwarranted. The arterial hypoxemia and increased alveolar arterial oxygen difference (A-aDo2) suggested maldistribution of ventilation compatible with pulmonary edema. Total compliance was decreased. Intermittent positive pressure breathing with oxygen generally decreased the A-aDo2 within 48 to 72 hours. In one patient who was markedly hypoxemic the high pulmonary artery pressure was abolished following oxygen administration. The pneumonitis was noninfective at the onset. Prophylactic antibiotics did not prevent subsequent pulmonary infection. The mortality as a direct consequence of aspiration pneumonitis was 40%. The main factors contributing to this mortality were advanced age, low pH of gastric aspirate, prolonged hypoxemia, and infection in the lung and elsewhere.

References
1.
Heroy WH:  Unrecognised aspiration . Ann Thorac Surg 8:580-581, 1969.Article
2.
Mendelson CL:  The aspiration of stomach contents in the lungs during obstetric anesthesia . Amer J Obstet Gynec 52:191-205, 1946.
3.
Teaubeaut JR:  Aspiration of gastric contents: Experimental study . Amer J Path 28:51-67, 1952.
4.
Bannister WK, Sattilaro AJ:  Vomiting and aspiration during anesthesia . Anesthesiology 23:251-264, 1962.Article
5.
 Maternal mortality studies: Aspiration pneumonia (Mendelson's syndrome) , editorial. Canad Med Assoc J 93:556-557, 1965.
6.
Hamelberg WV, Bosomworth PP: Aspiration Pneumonitis . Springfield, Ill, Charles C Thomas Publisher, 1968.
7.
Awe WC:  The pathophysiology of aspiration pneumonitis . Surgery 60: 232-291, 1966.
8.
Greenfield LJ, Singleton RP, McCaffree DR, et al:  Pulmonary effects of experimental graded aspiration of hydrochloric acid . Ann Surg 170:74-86, 1969.Article
9.
Alexander IGS:  The ultrastructure of the pulmonary alveolar vessels in Mendelson's (acid pulmonary aspiration) syndrome . Brit J Anaesth 40: 408-414, 1968.Article
10.
Hamilton WF, Riley RL, Attyah AM, et al:  Comparison of Fick and dye injection methods of measuring cardiac output in man . Amer J Physiol 153:309-321, 1948.
11.
Moore FD: The Metabolic Care of the Surgical Patient . Philadelphia, WB Saunders Co, 1959.
12.
Dagher FJ, Lyons JH, Finalyson DC, et al:  Blood volume measurement: A critical study , in Welch CE (ed): Advances in Surgery . Chicago, Year Book Medical Publisher Inc, 1965, vol 1, pp 69-109.
13.
Moore FD, Olsen KH, McMurray JD, et al: The Body Cell Mass and the Supporting Environment: Body Composition in Health and Disease . Philadelphia, WB Saunders Co, 1963.
14.
Comroe JH, Forster RE, Dubois AB, et al: The Lung , ed 2. Chicago, Yearbook Medical Publisher Inc, 1962.
15.
Bendixen HH, Egbert LD, Hedley-Whyte J, et al: Respiratory Care . St Louis, CV Mosby Co, 1965.
16.
Castleman B, McNelly BN (eds):  Case records of the Massachussets General Hospital . New Eng J Med 282:1087-1096, 1970.Article
17.
Gump FE, Mashima Y, Kinney JM:  Measurement of extravascular lung water in surgical patients . Surg Forum 20:225-227, 1969.
18.
Altschule MD:  Acute pulmonary edema . Minn Med 38:605-612, 1955.
19.
Moseley RV, Doty DD:  Physiologic changes due to aspiration pneumonitis . Ann Surg 171:73-76, 1970.Article
20.
Prys-Roberts C, Kelman GR, Greenbaum R, et al:  Circulatory influences of artificial ventilation during nitrous oxide anaesthesia in man: II. Results: The relative influence of mean intrathoracic pressure and arterial carbon dioxide tension . Brit J Anaesth 39:533-548, 1967.Article
21.
Hedley-Whyte J, Pontoppidan H, Morris MJ:  The response of patients with respiratory failure and cardiopulmonary disease to different levels of constant volume ventilation . J Clin Invest 45:1543-1554, 1966.Article
22.
Bjork VO, Grenvik A, Holmedahl M, et al:  Cardiac output and oxygen consumption during respirator treatment . Acta Anaesth Scand 15 ( (suppl) ):158, 1964.Article
23.
Clowes GH Jr, Del Guercio LRM, Barwinsky J:  The cardiac output in response to surgical trauma . Arch Surg 81:212-222, 1960.Article
24.
Billig DM, Jordan PH Jr:  Hemodynamic and respiratory alterations after abdominal surgery . Amer J Surg 117:682-686, 1969.Article
25.
Border JN:  Systemic arteriovenous shunting in patients under severe stress: A common cause of high output heart failure . Surgery 60:225-231, 1966.
26.
Hermreck AS, Thai AP:  Mechanism for the high circulatory requirements in sepsis and septic shock . Ann Surg 170:677-695, 1969.Article
27.
Juler GL, Stemmer EA, Connolly JE:  Complication of prophylactic digitalisation in thoracic surgical patients . J Thorac Cardiovasc Surg 58:352-360, 1969.
28.
Teeney SM, Lamb TW:  Physiological consequences of hypoventilation and hyperventilation , in Fenn WO, Rahn R (eds): Handbook of Physiology: Respiration . Washington, DC, American Physiological Society, 1965, vol 2, p 979.
29.
Staub NC:  Respiration . Ann Rev Physiol 31:173-202, 1969.Article
30.
Bergofsky EH, Holtzman SA:  A study of the mechanisms involved in the pulmonary arterial pressor response to hypoxia . Circ Res 20:506-519, 1967.Article
31.
Clowes GHA Jr, Farrington GH, Zuschnerd W, et al:  Circulating factors in the etiology of pulmonary insufficiency and right heart failure accompanying severe sepsis (peritonitis) . Ann Surg 171:663-678, 1970.Article
32.
Said SI, Longacher JW, Davis RK, et al:  Pulmonary gas exchange during the induction of pulmonary edema in anesthetized dogs . J Appl Physiol 19:403-407, 1964.
33.
Cook CD, Mead J, Schrener GL, et al:  Pulmonary mechanics during induced pulmonary edema in anesthetized dogs . J Appl Physiol 14:177-186, 1959.
34.
Green GM:  Pulmonary clearance of infectious agents . Ann Rev Med 19:315-336, 1968.Article
35.
Skillman JJ, Parikh BM, Tanenbaum BJ:  Pulmonary arteriovenous admixture: Improvement with albumin and diuresis . Surgery 119:440-447, 1970.Article
×