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Coma Recovery Association, Inc.
Aspiration pneumonia is a common source of fever and breathing difficulties in patients still in a coma or at the lower levels of arousal. This type of pneumonia is an irritation of the lungs caused by contents of the mouth entering the airways rather than the digestive pathway. The irritation causes inflammation within the lungs which may result in fever and can produce a partial collapse (atelectasis) of the lung. If not vigorously attended to, infection may develop resulting in a serious bacterial pneumonia. The most susceptible individuals are those who cannot swallow well and who do not have a good cough reflex. Even though these individuals may be on tube feedings with direct insert of feedings into the stomach, bypassing the mouth and throat, stomach contents may be regurgitated into the throat and then slide down the airway into the lungs. Even the persons’s own saliva may run into the lungs if a good swallowing mechanism is not present. Prevention of aspiration pneumonia and its complications can most often be accomplished by feeding the patient in an appropriate upright position, even when on tube feedings, and maintaining the upright position for 30-45 minutes after completion of feeding. When there is copious production of saliva, frequent suctioning of the mouth and swabbing the mouth with a dry cloth will help avoid pooling of saliva in the back of the mouth with resultant aspiration of the saliva. For those who still have a tracheostomy, quick removal of any coughed up material on the end of the tracheostomy tube will keep mucous and other substances from being sucked (aspirated) back into the lungs on the next inhalation. Occasionally, frequent suctioning through the tube may be necessary. Between feedings, frequent changing of position, clapping or cupping the chest, use of a vibrator over the chest and breathing exercises help keep the lungs expanded and to loosen up any material that needs to be coughed out or suctioned out. While aspiration pneumonia can frequently be prevented and usually can be treated when it occurs, aspiration pneumonia can also cause a patient to stop breathing and to succumb to the aspiration, hence the importance of being aware of the condition, treating it vigorously when it occurs, and using all the methods possible to prevent its occurrence. Mihai Dimancescu, MD Copyright © 1989-2000, * Coma Recovery Association, Inc.
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