İntraoperatif Aspirasyon ve Perioperatif Aspirasyon Pnömonisi Tedavisi
Özet
İntraoperatif aspirasyon, genel anestezi sırasında gastrik içeriğin akciğerlere kaçmasıyla karakterize, her 2000 vakadan birinde görülebilen ve yüksek morbidite riski taşıyan kritik bir durumdur. Tanı; ani hipoksi, taşikardi, havayolu basınçlarında artış veya gastrik içeriğin doğrudan görülmesiyle konur. Müdahalede hastanın Trendelenburg pozisyonuna getirilmesi ve hızla havayolu temizliğinin yapılması esastır. Risk faktörleri arasında obezite, acil cerrahi ve preoperatif açlık süresine uyulmaması öne çıkarken; önlemede ASA açlık kılavuzlarına uyum ve hızlı sıralı indüksiyon (HSİ) kritik rol oynar. Aspirasyon sonrası gelişen aspirasyon pnömonisi, orofaringeal veya gastrik içeriğin akciğerlerde enfeksiyon oluşturmasıdır. Tedavi, enfeksiyonun geliştiği yere (toplum veya hastane) ve hastanın risk faktörlerine göre belirlenen ampirik antibiyoterapiyi içerir. Son 90 gün içinde intravenöz antibiyotik kullanımı, MRSA ve Pseudomonas gibi dirençli patojenler için en önemli risk faktörüdür. Şiddetli vakalarda yoğun bakım takibi, akciğer koruyucu ventilasyon veya ECMO desteği gerekebilir. Prognoz, erken tanı, uygun antimikrobiyal tedavi ve altta yatan komorbiditelerin yönetimine bağlıdır.
Intraoperative aspiration is a critical condition characterized by the entry of gastric contents into the lungs during general anesthesia, occurring in 1 out of every 2000 cases and carrying a high risk of morbidity. Diagnosis is established through signs such as sudden hypoxia, tachycardia, increased airway pressures, or direct visualization of gastric contents. Immediate intervention involves placing the patient in the Trendelenburg position and rapid airway suctioning. Risk factors include obesity, emergency surgery, and non-compliance with preoperative fasting; prevention relies on adhering to ASA fasting guidelines and employing rapid sequence induction (RSI). Aspiration pneumonia, which develops following aspiration, is a pulmonary parenchymal infection caused by oropharyngeal or gastric contents. Treatment involves empirical antibiotic therapy determined by the setting of infection (community or hospital) and the patient's risk factors. Intravenous antibiotic use within the last 90 days is the most significant risk factor for resistant pathogens such as MRSA and Pseudomonas. Severe cases may require intensive care monitoring, lung-protective ventilation, or ECMO support. Prognosis depends on early diagnosis, appropriate antimicrobial therapy, and the management of underlying comorbidities.
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