Background: Aspiration pneumonitis also called as Mendelson's syndrome is a lung injury from acute inflammation that occurs after chemical burns in the airways and lung parenchyma, caused by the inhalation of gastric content. Depending on the quantity, nature of the aspirated material, and the host factors, the damage can lead to acute respiratory distress with a mortality rate up to 70%.
Case report: A 73-year-old male, was admitted from the emergency department to cardiovascular surgery ICU, diagnosed with ruptured abdominal aortic aneurysm. The patient presented with severe hypotension, tachycardic with altered mental status and was immediately sent to the operating room. At the moment of shifting to the operating table, the patient had cardiocirculatory arrest, large amount of gastric content came out of the patient’s mouth. While the patient was assisted with chest compressions, suction was immediately done in the oropharyngeal cavity, the patient was intubated with direct laryngoscopy, the tube cuff had its adequate pressure assured to prevent further aspiration.Bronchial lavage was performed before patient ventilation. The cardiac rhythm was restored, and the surgical incision started. Within 30 minutes from the aspiration, during the surgery the patient appeared symptoms of Mendelson’s syndrome. The arterial blood gas test was presented with hypoxemia in 100% with retention. Empiric antibiotic and corticosteroid were administered. After the surgery the patient was transferred to the ICU and was ventilated according to the ARDS protocol. The patient had other complications during his stay in ICU and was extubated after nine days and was discharged home after 19 days.
Discussion: Regardless of the measures taken to avoid aspiration pneumonia during emergency surgery, it is sometimes inevitable and it is important to know how to act and treat the patient according to the primary underlying condition.
Conclusions: Treatment with early, empiric, broad-spectrum antibiotics should be administered then selection of pathogen specific antibiotics or decision to stop or continue the use of antibiotics is made based on quantitative bacteriology
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