Aspiração pulmonar como processo biológico: por vezes inevitável e pouco compreendida
Pulmonary aspiration as a biological process: inevitable and insufficiently explored
Guilherme Maia Zica; Maria Inês Rebelo Gonçalves
Resumo
A aspiração pulmonar é um processo biológico que ocorre quando partículas sólidas ou líquidas entram para o interior das vias aéreas inferiores, ou seja, abaixo das pregas vocais. Esse mecanismo pode ter consequências que variam de nenhuma lesão até a morte em poucos minutos(1) . Há relatos de pacientes disfágicos desde 1800, publicados e descritos por Helsham no The Medical and Physical Journal(2) . A aspiração pulmonar começou a ser discutida na literatura em 1937, sempre como sequela indesejada de diferentes comorbidades(3) . Evidentemente, o objetivo fundamental de qualquer fonoaudiólogo que atue em disfagia é minimizar ou evitar a ocorrência da aspiração pulmonar(4) . Ao longo dos anos, profissionais da área da saúde como fonoaudiólogos, pneumologistas e enfermeiros tentaram compreender melhor suas repercussões clínicas e seu manejo(5) . Na literatura, a aspiração pulmonar é amplamente mencionada como sequela ou achado clínico secundário a uma comorbidade como disfagia(5,6) , distúrbios gastrointestinais(7) , traqueostomia(8,9) e ventilação mecânica(10,11) . Porém, ainda não encontramos estudos que a descreva com profundidade como um processo biológico e suas repercussões, achados e parâmetros clínicos. Existem diversos questionamentos sobre esse mecanismo que os clínicos ainda não conseguem compreender, como: existe um limite considerado “normal” para ocorrência de aspiração pulmonar? Em que ponto seria considerada um risco para vida? Existe algum nível de tolerância e/ou mecanismo de defesa do organismo para esse distúrbio? Algumas pessoas são mais suscetíveis a complicações? Como prevenir e/ou controlar um achado clínico tão pouco compreendido e, por muitas vezes, inevitável? É evidente que ainda não existe uma resposta correta ou unânime para todos esses questionamentos na literatura científica. Assim, buscamos organizar por meio de categorias o que encontramos na literatura em associação com nossa experiência clínica e interprofissional até o momento, visando questionar, refletir, incentivar e direcionar o interesse, discussões e pesquisas sobre a aspiração pulmonar como um processo biológico.
Abstract
Pulmonary aspiration is a biological process that occurs when solid or liquid particles enter the lower airways, that is, below the vocal folds. This mechanism can lead to outcomes ranging from no injury to death within a few minutes(1) . Reports of dysphagic patients have been published since the 1800s, first described by Helsham in The Medical and Physical Journal(2) . Pulmonary aspiration began to be discussed in the scientific literature in 1937, invariably reported as an undesirable sequela of various comorbidities(3) . Evidently, the primary goal of any speech-language pathologist working with dysphagia is to minimize or prevent the occurrence of pulmonary aspiration(4) . Over the years, healthcare professionals, including speech-language pathologists, pulmonologists, and nurses, have sought to better understand its clinical repercussions and management(5) . In the literature, pulmonary aspiration is widely mentioned as a sequela or clinical finding secondary to comorbidities such as dysphagia(5,6) , gastrointestinal disorders(7) , tracheostomy(8,9) , and mechanical ventilation(10,11) . However, studies providing an indepth description of pulmonary aspiration as a biological process, along with its clinical repercussions, findings, and parameters, are still lacking. There are several questions regarding this mechanism that clinicians have yet to fully understand, such as: Is there a threshold considered “normal” for pulmonary aspiration? At what point does pulmonary aspiration become life-threatening? Is there any level of tolerance and/or protective mechanism in the body against pulmonary aspiration? Are some individuals more susceptible to complications? How can such a poorly understood—and often unavoidable—clinical finding be prevented or managed? It is evident that there is still no definitive or unanimous answer to these questions in the scientific literature. Therefore, we aimed to organize, through specific categories, the findings reported in the literature in conjunction with our clinical and interprofessional experience to date, with the goal of questioning, reflecting, and stimulating interest, discussion, and research on pulmonary aspiration as a biological process.
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Submetido em:
21/03/2025
Aceito em:
07/04/2025
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