Prognosis
Aspiration of gastric contents results in limited disease in most patients. Aspiration can be asymptomatic, but it can result in chemical pneumonitis and acute respiratory distress syndrome (ARDS).[2] Mortality is high, however, if patients progress to ARDS. ARDS usually develops within 2-5 hours of aspiration, but can be delayed.[15] The clinical course is variable: in one small retrospective study, 12% of patients had a fulminant course and died shortly after aspiration of gastric contents; in 62% the chest x-ray improved rapidly within 5 days after aspiration; however, in 26% this initial improvement was followed by the development of new infiltrates on chest x-ray, probably indicating complicating bacterial pneumonia, and of this group over 60% died as a consequence.[77] The aspiration injury usually begins to resolve within 72 hours, if pneumonia or ARDS has not developed. Death as a result of aspiration of gastric contents as a consequence of anesthetic practice is rare, with rates varying from 0% to 5%, but is a leading cause of malpractice claims with high mortality in these reports.[8][12]
Because of the inert character of barium, long-term reactions and late toxicities are not usually expected, and complete radiologic clearance is the norm. There are no extensive data on long-term complications from massive barium aspiration, but case reports suggest that abnormalities can be seen on high-resolution computed tomography scan up to 1 year later.[108] Therefore, it is reasonable to obtain follow-up chest imaging during the year after barium aspiration.
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