Résumé
La pneumonie d’inhalation se définit par l’inhalation du contenu gastrique ou oropharyngé dans les voies aériennes inférieures. Les principaux mécanismes sont un retard à la vidange gastrique, une hypersecrétion gastrique, un reflux gastro-oesophagien, une atteinte laryngée. La cause essentielle est le trouble de la conscience. Les conséquences cliniques dépendent de la nature du liquide gastrique ou oropharyngé inhalé. La bactériologie est alors, soit négative, soit révélatrice d’une flore oropharyngée avec un rôle discutable des anaérobies. La prise en charge thérapeutique curative associe oxygénothérapie, ventilation mécanique si besoin et antibiothérapie. Le traitement préventif repose sur le jeûne avant une anesthésie générale, des conseils lors de la nutrition entérale et une bonne hygiène dentaire.
Abstract
Aspiration is defined as the aspiration of gastric (aspiration pneumonitis) or oropharyngeal (aspiration pneumonia) contents into the larynx and the lower respiratory tract. The principal mechanisms are delay in gastric empting, gastric oversecretion, gastroesophageal reflux, laryngeal alteration. The main cause is the alteration of consciousness. The clinical consequences depend on the nature of the gastric or oropharyngeal aspirated secretions. Bacteriology is then either negative or positive for oropharyngeal flora, with a debatable role for the anaerobes. The treatment includes oxygenotherapy, mechanical ventilation if necessary and antimicrobial treatment. Preventive strategies include fast before a general anesthesia, a protocol for enteral feeding, and good oral hygiene.
Article PDF
Références
Marik PE (2001) Aspiration pneumonitis and aspiration pneumonia. N Engl J Med 344:665–71
Mendelson CL (1946) The aspiration of stomach contents into the lungs during obstetric anesthesia. Am J Obstet Gynecol 52:191–205
Rebuck JA, Rasmussen JR, Olsen KM (2001) Clinical aspirationrelated practice patterns in the intensive care unit: a physician survey. Crit Care Med 29:2239–44
Adnet F, Baud F (1996) Relation between Glasgow coma scale and aspiration pneumonia. Lancet 348:123–4
De Toledo JC, Lowe MR, Gonzalez J, Haddad H (2004) Risk of aspiration pneumonia after an epileptic seizure: a retrospective analysis of 1634 adult patients. Epilepsy Behaviour 5:593–5
Isbister G, Downes F, Sibbritt D, et al (2004) Aspiration pneumonitis in an overdose population: Frequency, predictors and outcomes. Crit Care Med 32:88–93
Christ A, Arranto CA, Schindler C, et al (2006) Incidence, risk factors, and outcome of aspiration pneumonitis in ICU overdose patients. Intensive Care Med 32:1423–7
Eizadi-Mood N, Saghaei M, Alfred S, et al (2009) Comparative evaluation of Glasgow Coma Score and gag reflex in predicting aspiration pneumonitis in acute poisoning. J Crit Care 24:470.e9–470.e15
Holas MA, DePippo KL, Reding MJ (1994) Aspiration and relative risk of medical complications following stroke. Arch Neurol 51:1051–3
Martino R, Foley N, Bhogal S, et al (2005) Dysphagia After Stroke Incidence, Diagnosis, and Pulmonary Complications. Stroke 36:2756–63
Ji R, Wang D, Shen H, et al (2013) Interrelationship among common medical complications after acute stroke Pneumonia plays an important role. Stroke 44:3436–44
Dewavrin F, Zerimech F, Boyer A, et al (2014) Accuracy of Alpha Amylase in Diagnosing Microaspiration in Intubated Critically-Ill Patients. PloS One 9:e90851
Lee AL, Button BM, Denehy L, et al (2014) Proximal and distal gastro-oesophageal reflux in chronic obstructive pulmonary disease and bronchiectasis. Respirology 19:211–7
Cvejic L, Harding R, Churchward T, et al (2011) Laryngeal penetration and aspiration in individuals with stable COPD. Respirology 16:269–75
Gross RD, Atwood CW, Ross SB, et al (2009) The Coordination of Breathing and Swallowing in Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med 179:559–65
Terzi N, Normand H, Dumanowski E, et al (2014) Noninvasive Ventilation and Breathing-Swallowing Interplay in Chronic Obstructive Pulmonary Disease. Crit Care Med 42:565–73
Clayton NA, Carnaby GD, Peters MJ, Ing AJ (2014) Impaired laryngopharyngeal sensitivity in patients with COPD: The association with swallow function. Int J Speech Lang Pathol 16:615–23
Knol W, van Marum RJ, Jansen PA, et al (2008) Antipsychotic drug use and risk of pneumonia in elderly people. J Am Geriatr Soc 56:661–6
Metheny NA, Schallom ME, Edwards SJ (2004) Effect of gastrointestinal motility and feeding tube site on aspiration risk in critically ill patients: A review. Heart Lung 33:131–45
Mizoch BA (2007) Risk of aspiration in patients on enteral nutrition: frequency, relevance, relation to pneumonia, risk factors, and strategies for risk reduction. Curr Gastroenterol Rep 9:338–44
Reignier J, Mercier E, Le Gouge A, et al (2013) Effect of not monitoring residual gastric volume on risk of ventilator associated pneumonia in adults receiving mechanical ventilation and early enteral feeding a randomized controlled trial. JAMA 309:249–56
Robert D (2004) Troubles de déglutition postextubation et posttrachéotomie. Réanimation 13:417–30
Macht M, Wimbish T, Clark BJ, et al (2011) Postextubation dysphagia is persistent and associated with poor outcomes in survivors of critical illness. Crit Care 15:R231
Skoretz SA, Flowers HL, Martino R (2010) The Incidence of Dysphagia Following Endotracheal Intubation A Systematic Review. Chest 137:665–73
Ponfick M, Linden R, Nowak DA (2015) Dysphagia: a common, transient symptom in critical illness polyneuropathy: a fiberoptic endoscopic evaluation of swallowing study. Crit Care Med 43:365–72
Lienhart A, Auroy Y, Péquinot F, et al (2004) Preliminary results from the SFAR-INSERM inquiry on anaesthesia-related deaths in France: Mortality rates have fallen ten-fold over the past two decades. Bull Acad Natl Med 188:1429–37
Debaene B, Jeanny A (2005) Anesthésie pour estomac plein. Les essentiels. Elsevier eds 263–77
Gleeson K, Eggli DF, Maxwell SL (1997) Quantitative aspiration during sleep in normal subjects. Chest 111:1266–72
Exarhos ND, Logan WD, Abbott OA, Hatcher CR (1965) The importance of pH and volume in tracheobronchial aspiration. Dis Chest 47:167–9
James CF, Modell JH, Gibbs CP, et al (1984) Pulmonary aspiration-effects of volume and pH in the rat. Anesth Analg 63:665–8
Richard JC, Guérin C (2006) Modèles animaux de SDRA. Réanimation 15:21–2
Kennedy TP, Johnson KJ, Kunkel RG, et al (1989) Acute acid aspiration lung injury in the rat: biphasic pathogenesis. Anesth Analg 69:87–92
Scannapieco FA, Papandonatos GD, Dunford RG (1998) Associations between oral conditions and respiratory disease in a national sample survey population. Ann Perodontol 3:251–6
Mojon P (2002) Oral health and respiratory infection. J Can Dent Assoc 68:340–5
DiBardino DM, Wunderink RG (2015) Aspiration pneumonia: a review of modern trends. J Crit Care 30:40–8
Smith SR, Waterer G, Wunderink R (2013) Trends in pneumonia: incidence, pathogens, and outcomes from 1993-2010. ATS International Conference, Philadelphia, PA, May 19, 2013
El-Solh AA, Vora H, Knight PR, Porhomayon J (2011) Diagnostic utility of serum procalcitonin levels in pulmonary aspiration syndromes. Crit Care Med 39:1251–6
Weiss CH, Moazed F, DiBardino D, et al (2013) Bronchoalveolar lavage amylase is associated with risk factors for aspiration and predicts bacterial pneumonia. Crit Care Med 41:765–73
Bartlett JG, Gorbach SL, Finegold SM (1974) The bacteriology of aspiration pneumonia. Am J Med 56:202–7
Robert R, Grollier G, Hira M, Doré P (2000) A role for anaerobic bacteria in patients with ventilator acquired pneumonia: yes or no? Chest 117:1214–5
Marik PE, Careau P (1999) The role of anerobes in patients with ventilator-associated pneumonia and aspiration pneumonia a prospective study. Chest 115:178–83
El-Solh AA, Pietrantoni C, Bhat A, et al (2003) Microbiology of severe aspiration pneumonia in institutionalized elderly. Am J Respir Crit Care Med 167:1650–4
Tokuyasu H, Harada T, Watanabe E, et al (2009) Effectiveness of meropenem for the treatment of aspiration pneumonia in elderly patients. Intern Med 48:129–35
Takayanagi N, Kagiyama N, Ishiguro T, et al (2010) Etiology and outcome of community-acquired lung abscess. Respiration 80:98–105
Wang JL, Chen KY, Fang CT, et al (2005) Changing bacteriology of adult community-acquired lung abscess in Taiwan Klebsiella pneumonia versus anaerobes. Clin Infect Dis 40:915–22
Lobo LJ, Reed KD, Wunderink RG (2010) Expanded clinical presentation of community-acquired methicillin-resistant staphylococcus aureus pneumonia. Chest 138:130–6
Bartlett JG, Gorbach SL (1975) The triple threat of aspiration pneumonia. Chest 68:560–6
Cesar L, Gonzalez C, Calia FM (1975) Bacteriologic flora of aspiration-induced pulmonary infections. Arch Intern Med 135: 711–4
Lorber B, Swenson RM (1974) Bacteriology of aspiration pneumonia. A prospective study of community- and hospital-acquired cases. Ann Intern Med 81:329–31
Brook I, Finegold SM (1980) Bacteriology of aspiration pneumonia in children. Pediatrics 65:1115–20
Wolfe JE, Bone RC, Ruth WE (1977) Effects of corticosteroids in the treatment of patients with gastric aspiration. Am J Med 63:719–22
Leroy O, Vandenbussche C, Coffinier C, et al (1997) Communityacquired aspiration pneumonia in intensive care units epidemiological and prognostic. Data Am J Respir Crit Care Med 156:1922–9
Kane-Gill SL, Olsen KM, Rebuck JA, et al (2007) Aspiration Evaluation Group of the Clinical Pharmacy and Pharmacology Section Multicenter treatment and outcome evaluation of aspiration syndromes in critically ill patients. Ann Pharmacother 41:549–55
Mandell LA, Wunderink RG, Anzueto A, et al (2007) Infectious diseases society of America thoracic society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis 44:S27–72
Levison ME, Mangura CT, Lorber B, et al (1983) Clindamycin compared with penicillin for the treatment of anaerobic lung abscess. Ann Intern Med 98:446–71
Gudiol F, Manresa F, Pallares R, et al (1990) Clindamycin vs penicillin for anerobic lung infections. High rate of penicillin failures associated with penicillin-resistant bacteroides melaninogenicus. Arch Intern Med 150:2525–9
Perlino CA (1981) Metronidazole vs clindamycin treatment of anaerobic pulmonary infection. Failure of metronidazole therapy Arch Intern Med 141:1424–7
Kadowaki M, Demura Y, Mizuno S, et al (2005) Reappraisal of clindamycin iv monotherapy for treatment of mild to moderate aspiration pneumonia in elderly patients. Chest 127:1276–82
Ott SR, Allewelt M, Lorenz J, et al (2008) Moxifloxacin vs ampicillin/ sulbactam in aspiration pneumonia and primary lung abscess. Infection 36:23–30
D’Escrivan T, Guery B (2005) Prevention and treatment of aspiration pneumonia in intensive care units. Treat Respir Med 4:317–24
Groher M (1990) The management of dysphagia in the chronic care setting. Dysphagia 5:57–8
DePippo KL, Holas MA, Reding MJ, et al (1994) Dysphagia therapy following stroke: a controlled trial. Neurology 44:1655–60
Suntrup S, Marian T, Schröder JB, et al (2015) Electrical pharyngeal stimulation for dysphagia treatment in tracheotomized stroke patients: a randomized controlled trial. Intensive Care Med 41:1629–37
Baeten C, Hoefnagels J (1992) Feeding via nasogastric tube or percutaneous endoscopic gastrostomy: a comparison. Scand J Gastroenterol 194(Suppl.):95–8
Drakulovic MB, Torres A, Bauer TT, et al (1999) Supine body position as a risk factor for nosocomial pneumonia in mechanically ventilated patients: A randomised trial. Lancet 354:1851–58
Van Nieuwenhoven CA, Vandenbroucke-Grauls C, Van Tiel FH, et al (2006) Faisability and effects of the semirecumbent position to prevent ventilator-associated pneumonia: a randomized study. Crit Care Med 34:396–402
Lefrant JY, Hurel D, Cano NJ, et al (2014) Nutrition artificielle en réanimation. Guidelines for nutrition support in critically ill patient. AFAR 33:202–18
Okuda K, Kimizuka R, Abe S, et al (2004) Involvement of periodontopathic anaerobes in aspiration pneumonia. J Periodontontol 76(Suppl.):2154–60
Müller F (2015) Oral hygiene reduces the mortality from aspiration pneumonia in frail elders. J Dent Res 94(3Suppl):14S–16S
Okaishi T, Morimoto S, Fukuo K, et al (1999) Reduction of risk of pneumonia associated with use of angiotensin I converting enzyme inhibitors in elderly inpatients. Am J Hypertens 12:778–83
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Chatellier, D., Cabasson, S. & Robert, R. Les pneumonies d’inhalation. Réanimation 25, 94–100 (2016). https://doi.org/10.1007/s13546-015-1155-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s13546-015-1155-2