Endotracheal aspirates

Sputum, bronchoscopic aspirates, endotracheal aspirates Several ml 1 10 -10 ... 

Pneumonia is inflammation of the lung with consolidation. The cause of the inflammation is infection, which can result from a wide range of organisms. There are five classifications of pneumonia community-acquired, aspiration, hospital-acquired, ventilator-associated, and health care-associated. Patients who develop pneumonia in the outpatient setting and have not been in any health care facilities, which include wound care and hemodialysis clinics, have community-acquired pneumonia (CAP). Aspiration is of either oropharyngeal or gastrointestinal contents. Hospital-acquired pneumonia (HAP) is defined as pneumonia that occurs 48 hours or more after admission.1,2 Ventilator-associated pneumonia (VAP) requires endotracheal intubation for at least 48 to 72 hours before the onset of... 

Intubation and mechanical ventilation increase the risk of HAP/VAP 6- to 21 -fold.2,22 VAP also may be related to colonization of the ventilator circuit23 Risk of aspiration is increased in these patients owing to the supine positioning of the patient, the presence of the endotracheal tube preventing closure of the... 

Uses quantitative culture of endotracheal aspirates, bronchoalveolar lavage (BAL), or protected specimen brush (PSB). 

Bronchial secretions An increased volume of liquefied bronchial secretions may occur when cough is inadequate, maintain an open airway by mechanical suction if necessary. When there is a large mechanical block due to a foreign body or local accumulation, clear the airway by endotracheal aspiration, with or without bronchoscopy. 

Therapeutic uses Because of its rapid onset and short duration of action, succinylcholine is useful when rapid endotracheal intubation is required during the induction of anesthesia (a rapid action is essential if aspiration of gastric contents is to be avoided during intubation). It is also employed during electroconvulsive shock treatment. 

Hydrocarbons, e.g. paraffin oil (kerosene), petrol (gasoline), benzene, chiefly cause CNS depression and pulmonary damage from inhalation. It is vital to avoid aspiration into the lungs during attempts to remove the poison or in spontaneous vomiting. Gastric aspiration should be performed only if a cuffed endotracheal tube is effectively in place, if necessary after anaesthetising the subject. 

Complications cannot be attributed to endoscopy itself, but to the pre-existing conditions localized perforations, risks associated with aspiration, cardiac problems, lowered blood pressure, etc. Premedication may therefore be inappropriate in individual cases, and endotracheal intubation or endotracheal anaesthesia is then indicated. 

An 8-year-old girl with asthma underwent tonsillectomy and adenoidectomy hemostasis was performed with bismuth-adrenaline paste. A small amount of bismuth was noted in the endotracheal tube before extu-bation, and in the recovery room she developed respiratory difficulty associated with nasal flaring and sternal retraction. A chest X-ray showed aspirated radio-opaque material outlining the tracheobronchial tree and early pulmonary infiltrates. 

Persons providing medical assistance should avoid contact with contaminated clothing. Contaminated clothing should be removed, bagged, and discarded. Exposed dermal areas should be cleaned thoroughly with soap and water. Exposed eyes should be flushed with generous amounts of clean water for at least 15 min. If necessary, use an endotracheal tube to maintain a clear airway, aspirate any secretions, and provide oxygen via mechanical ventilation. 

If vomiting occurs, pulmonary aspiration should be watched for. In cases of respiratory compromise, airway and respiration should be secured via endotracheal entubation. Patients who have bronchospasm should be treated with aerosolized bronchodilators. Epinephrine or related substances should not be administered. There is no antidote for gasoline. Treatment should support respiratory and cardiovascular functions. 

Cardiac and respiratory stabilization are the first priorities following pentazocine poisoning. The patient s airway should be patent and adequate ventilation assured. If the patient has either inadequate ventilation or a poor gag reflex, then the patient may be at risk for subsequent CO2 narcosis with worsening acidosis or aspiration. If necessary, endotracheal tube intubation should be performed. Close monitoring of the patient s pulmonary exam should be performed to assure that pulmonary edema does not develop. The health care providers should place the patient on continuous cardiac monitoring with pulse oximetry and make frequent neurological checks. 

B. Perform endotracheal intubation if personnel trained in the procedure are available. Intubation of the trachea provides the most reliable protection of the ainvay, preventing aspiration and obstmcfion and allowing for mechanically assisted ventilation. However, it is not a simple procedure and should be attempted only by those with training and experience. Complications include vomiting with pulmonary aspiration local trauma to the oropharynx, nasopharynx, and larynx inadvertent intubation of the esophagus or a main-stem bronchus and failure to intubate the patient after respiratory arrest has been... 

After thoracotomy and lobectomy, a 67-year-old male who had been administered a paravertebral catheter with continuous infusion plus multiple bolus doses of 20 mL 0.1% bupivacaine postoperatively developed tonic-clonic seizures and subsequent pulmonary aspiration. He was initially treated with intravenous (IV) midazolam and endotracheal intubation. Unforhmately the patient succumbed to aspiration pneumonitis and acute respiratory distress syndrome 3 days later in the intensive care xmit. 

Spray SB, Zuidema GD, Cameron JL. Aspiration pneumonia incidence of aspiration with endotracheal tubes. Am J Surg 1976 131 701-703. 

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