Foreign Body Aspiration

Any inhalation (aspiration) of foreign matter (liquids, solid objects) must be handled with extreme caution that can be even life-threatening.

Causes

Aspiration of solid bites usually happens when eating. The risk factors include inattention, speaking during meals, or drunkenness. Aspiration is also common in people with disorders of swallowing (see the related article). Inhalation of liquids may occur during normal drinking, but the most serious cases occur when drowning. A quite special issue is the aspiration of gastric contents during vomiting or reflux disease.

 

Foreign body aspiration

 

Scheme - aspirated foreign body (mostly falls to the bottom of the right lung)

 

Symptoms

The main symptom is defensive dry cough and shortness of breath. Sudden lack of oxygen may cause an acute unconsciousness. Larger foreign bodies may irritate the respiratory tract* to such extent that the larynx and bronchi reflexively constrict (laryngospasm and bronchospasm). This situation may be followed by sudden death by suffocation. Small amount of fluid may not be a problem, but the situation depends on its salinity. Normal fresh water can be quickly absorbed from the lungs into the blood, but salty sea water may cause further absorption of blood fluid into the lung alveoli (osmotically due to high concentration of ions) and thus worsen the situation.

 

Pneumonia is an unpleasant complication of aspirated bodies. The inflammation may be either infectious or non-infectious (chemical). Very serious chemical pneumonia may occur after inhalation of acid gastric contents (so-called Mendelson's syndrome). Infectious pneumonias are caused by bacteria from the inhaled foreign body.

 

* Note: There is special and insidious situation when the inhaled object is small enough to penetrate through vocal cords into the trachea, but it is too big to fit into the bronchi. Such body is repeatedly ejected by defensive cough towards the vocal cord, but it is unable to pass into the larynx. The resulting irritation of the lower respiratory tract is enormous.

Diagnosis

The information about aspiration can be obtained from the patient or from close persons. Some contrast objects can be seen on the chest X-ray and so is the eventual pneumonia. The precise location of any solid object can be determined by a bronchoscope, which can be also used to extract the body (see Treatment).

Treatment

First aid in inhalation of a solid body is the Heimlich maneuver when we hug the affected person’s abdomen from behind and repeatedly push the abdomen to increase the chest pressure to oust the object out of the airways. If this does not help, the best option is therapeutic bronchoscopy (endoscopy of the lower respiratory tract) with mechanic removal of the object. Any resulting infectious pneumonias should be treated by antibiotics.