Chest
Volume 68, Issue 4, October 1975, Pages 560-566
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Critical Review
The Triple Threat of Aspiration Pneumonia

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Aspiration of Toxic Fluids

Certain fluids are toxic to the lower respiratory tract and can initiate an inflammatory reaction which is independent of bacterial infection. Examples include acids, animal fats, mineral oil, alcohol and hydrocarbons.25, 26, 27, 28, 29, 30, 31, 32, 33 Of these, gastric acid is the most frequently encountered and the most completely studied.

The toxic effect of acid on the lung was originally reported by Winternitz et al33 in an experimental animal study of irritant war gases during World War I.

Aspiration of Pathogenic Bacteria

The most common form of aspiration pneumonia bears the hallmarks of bacterial pulmonary infection from the start, namely fever and purulent sputum. This condition is a less fulminant process than acid pneumonitis, and the actual episode of aspiration is seldom observed. The diagnosis, however, is suspect when typical symptoms occur in a susceptible host who has roentgenographic changes in a dependent pulmonary segment.

Presentation: The course of bacterial infections following aspiration was

Aspiration of Inert Substances

Patients may aspirate material which has no toxic effect on the lung but causes pulmonary complications by mechanical obstruction or by a reflex mechanism.

Fluids: Fluids which produce no distinctive pulmonary lesions include saline solution, water, barium, and neutralized gastric contents.3, 16, 57, 58 Intratracheal inoculation of limited quantities of these substances to anesthesized animals generally causes only transient respiratory distress. Certain animal studies using precise physiologic

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