Comatose Patients and the Risk of Aspiration Pneumonia

Aspiration pneumonia refers to inflammation of the lungs due to inhalation of foreign matters (food, saliva, nasal secretions). Virtually any fluids or solid irritants (dust particles) that frequently enter the airways can lead to the occurrence of aspiration pneumonia. Aspiration pneumonia can generate moderate or high fever due to inflammation of the lower respiratory tract's soft tissues, membranes and organs involved in the process of breathing. Unattended, this type of pneumonia can result in partial lung failure (atelectasis). Although aspiration pneumonia is not an infectious disease, in time it can lead to serious pulmonary bacterial infections. On the premises of lung inflammation and weakened defenses of the respiratory system (cilia barriers, mucus), aspiration pneumonia facilitates the occurrence of severe bacterial pneumonia. Furthermore, aspiration pneumonia can even lead to death by asphyxiation (due to obstruction of breathing).

The categories of people exposed to the highest risk of developing aspiration pneumonia are: people who can not swallow properly or have a poor cough reflex (infants, very young children, the elderly) and people with serious disabilities that involve bed confinement. Aspiration pneumonia is very common in comatose patients and people who suffer from paralysis, as immobility and prolonged horizontal position of the body render them very susceptible to inhalation of their own mouth and nasal secretions. Also, prolonged bed confinement can lead to regurgitation of the stomach content inside the throat and mouth, allowing stomach fluids to reach the upper levels of the respiratory tract, from where they may be inhaled into the lungs. Despite the fact that comatose patients are usually fed via tubes that enter directly inside the stomach, they are still exposed to a high risk of aspiration pneumonia as a result of stomach fluids reflux into the throat and mouth.

The occurrence of aspiration pneumonia in disabled or comatose patients can be easily prevented by slightly elevating patients' head and torso during feedings. Patients should be maintained in this position for at least 30 minutes after feeding. This procedure is recommended for patients who receive tube feedings as well. Patients who suffer from an overproduction of saliva also require special medical care. In order to prevent the inhalation of excess saliva, this category of patients should be kept under permanent medical monitoring. Constant mouth suctioning and frequent wiping of the mouth and nose can prevent the occurrence of aspiration pneumonia in such patients. Constant changing of position can also minimize the risk of aspiration pneumonia in disabled and comatose patients.

Patients who present signs of fluid inhalation need immediate medical assistance. Tube suctioning of the airways is an effective means of clearing patients' respiratory tract from inhaled foreign matters. Chest massage and application of pressure on patients' chest can stimulate cough reflexes, thus allowing the elimination of inhaled matters.

Although aspiration pneumonia is highly preventable and treatable (if timely discovered), it still accounts for many deaths among patients with special conditions. People with poor freedom of movement and immobile people need permanent surveillance in order to prevent the occurrence of aspiration pneumonia.