Abstract

Pulmonary aspiration of gastric contents can cause a spec-trum of sequelae that spans from relatively minor to rapidly lethal disease. To emphasize the extent of this spectrum and to encompass both noninfectious complications and infection, we use the term "aspiration-induced pulmonary injury " rather than "aspiration pneumonia. " In this article we review the relevant literature, focusing on more recent insights into the pathogenesis of lung injury, the natural history of aspiration, risk factors, the relationship between aspiration and infection, and recommendations for manage-ment. TIle relevance to human disease of studies using intra· airway acid instillation in animals is questioned. \'\'e discuss the difficulties in predicting the clinical course after aspira-tion. We identify risk factors for aspiration-induced pulmo-nary injury that are commonl} ' encountered in the intensive care unit, and discuss in detail factors of special interest to the intensivist, including the impact of tr.!cheal intubation; the cffccts ofenteric intubation, particularly the comparison between pre- and postpyloric routes of enteric feeding ad· ministration; and the relative risks associatcd with particular feeding protocols. We conclude with recommendations re-garding treatment and prcvention strategies.