Key messages

• Aspiration of gastric contents is generally preventable by good anesthetic practice and attention to detail on the intensive care unit.

• Mortality remains high in those requiring mechanical ventilation for more than 24 h.

• Aspiration of gastric contents with pH greater than 3 is not benign; food particles, even at neutral pH, are directly pathogenic to the airways and lung parenchyma.

• The presence of an endotracheal tube, even with cuff inflated, does not guarantee complete protection against aspiration Incidence

The aspiration of gastric contents is a feared complication in the obtunded patient. The incidence is uncertain, as the diagnosis is not always clear and there is a significant incidence of subclinical aspiration. The incidence varies according to the underlying disorder; clinically significant aspiration occurs in approximately 1 in every 3900 cases with anesthesia for elective surgery and 1 in 895 with anesthesia for emergency surgery, but in up to 8 to 19 per cent of cases during non-anesthetic emergency intubations.

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