Resumen
Definición
Anamnesis y examen
Principales factores de diagnóstico
- presencia de factores de riesgo
- tos incoercible
- fiebre
- disnea
- sibilancia
- crepitaciones
Factores de riesgo
- disminución del nivel de consciencia (puntuación <9 en la Escala de Coma de Glasgow)
- mayor gravedad de la enfermedad
- anestesia general
- edad >70 años
- sexo masculino
- traumatismo de cráneo
- enfermedad cerebrovascular
- tubo endotraqueal o cánula de traqueotomía
- disfagia
- complicaciones en las vías respiratorias
- papilla de bario
- enfermedad por reflujo gastroesofágico
- sondas de alimentación
- posición en decúbito supino
- vaciamiento gástrico retrasado
- obesidad
- fármacos que reducen el tono del esfínter esofágico
Pruebas diagnósticas
Primeras pruebas diagnósticas para solicitar
- radiografía de tórax
Pruebas diagnósticas que deben considerarse
- tomografía computarizada (TC) de tórax
- broncoscopia con lavado broncoalveolar
- hemograma completo (HC)
- gasometría arterial
Algoritmo de tratamiento
neumonitis por aspiración de contenido gástrico
neumonitis por aspiración de bario
neumonitis no resuelta después de 48 horas
Colaboradores
Autores
Madison Macht, MD
Volunteer Clinical Faculty
Division of Pulmonary Sciences and Critical Care Medicine
University of Colorado Denver
Aurora
CO
Divulgaciones
MM declares that he has no competing interests.
Agradecimientos
Dr Madison Macht would like to gratefully acknowledge Dr Kamran Mahmood, Dr Scott Shofer, Dr Septimiu Murgu, and Dr Henri Colt, previous contributors to this topic.
Divulgaciones
KM, SS, SM, and HC declare that they have no competing interests.
Revisores por pares
Andrew Parfitt, MBBS, FFAEM
Clinical Director
Acute Medicine
Associate Medical Director
Consultant Emergency Medicine
Guy's and St Thomas' NHS Foundation Trust
Clinical Lead and Consultant
Accident and Emergency Medicine
St Thomas' Hospital
London
UK
Divulgaciones
AP declares that he has no competing interests.
Momen M. Wahidi, MD, MBA
Director
Interventional Pulmonology
Division of Pulmonary, Allergy, and Critical Care Medicine
Assistant Professor of Medicine
Duke University Medical Center
Durham
NC
Divulgaciones
MMW declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
Referencias
Artículos principales
Marik PE. Aspiration pneumonitis and aspiration pneumonia. N Engl J Med. 2001 Mar 1;344(9):665-71. Resumen
Ng A, Smith G. Gastroesophageal reflux and aspiration of gastric contents in anesthetic practice. Anesth Analg. 2001 Aug;93(2):494-513.Texto completo Resumen
Metheny NA, Clouse RE, Chang YH, et al. Tracheobronchial aspiration of gastric contents in critically ill tube-fed patients: frequency, outcomes, and risk factors. Crit Care Med. 2006 Apr;34(4):1007-15.Texto completo Resumen
Smith Hammond CA, Goldstein LB. Cough and aspiration of food and liquids due to oral-pharyngeal dysphagia: ACCP evidence-based clinical practice guidelines. Chest. 2006 Jan;129(1 suppl):154S-68S.Texto completo Resumen
Boyd M, Chatterjee A, Chiles C, et al. Tracheobronchial foreign body aspiration in adults. South Med J. 2009 Feb;102(2):171-4. Resumen
Paintal HS, Kuschner WG. Aspiration syndromes: 10 clinical pearls every physician should know. Int J Clin Pract. 2007 May;61(5):846-52. Resumen
Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: Application to healthy patients undergoing elective procedures: an updated report by the American Society of Anesthesiologists Task Force on preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration. Anesthesiology. 2017 Mar;126(3):376-93.Texto completo Resumen
Smith I, Kranke P, Murat I, et al. Perioperative fasting in adults and children: guidelines from the European Society of Anaesthesiology. Eur J Anaesthesiol. 2011 Aug;28(8):556-69.Texto completo Resumen
Australian and New Zealand Society for Geriatric Medicine. Australian and New Zealand Society for Geriatric Medicine. Position statement - dysphagia and aspiration in older people. Australas J Ageing. 2011 Jun;30(2):98-103. Resumen
Artículos de referencia
Una lista completa de las fuentes a las que se hace referencia en este tema está disponible para los usuarios con acceso a todo BMJ Best Practice.
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- Síndrome de dificultad respiratoria aguda
- Exacerbación asmática
- Fibrosis quística con exacerbación
Más DiferencialesGuías de práctica clínica
- Diagnosis and treatment of adults with community-acquired pneumonia: an official clinical practice guideline
- ACR appropriateness criteria: dysphagia
Más Guías de práctica clínica
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