Aspiration pneumonia is caused by a direct chemical insult due to the entry of a foreign substance, solid or liquid, into the respiratory tract. Chemical pneumonitis, bacterial pneumonia, or airway obstruction can occur. Sometimes, the cause may be unknown which makes differentiating a diagnosis quite difficult. The aspirated fluid can be formed from oropharyngeal secretions or particulate matter or can also be gastric content. Hemodynamically unstable patients with aspiration events. Sometimes, an individual needs support to breathe during the course of the illness. Treatment involves antibiotics and supportive care for breathing. Complications of disease include lung abscess and empyema. It is estimated that aspiration pneumonia accounts for 5 to 15% of cases of communityacquired pneumonia, but figures for hospitalacquired pneumonia are unavailable. The choice of oral or intravenous therapy is made on a casebycase basis depending on the clinical condition of the patient and the ability of the patient to tolerate oral therapy.
Two pathways with different empiric treatment regimens based on risk of infection with multidrugresistant mdr pathogens including mrsa, pseudomonas spp. Individuals with aspiration pneumonia may need to receive supplemental oxygen as part of their treatment regimen. Depending on how far down the airway system the obstruction is, you may need suctioning of the upper airway the trachea or a bronchoscopy. Markers placed in the stomach can often be detected in the lungs of healthy persons using scintigraphic methods. Therapy is the same as empiric therapy for non aspiration pneumonia, whether it is communityacquired, hospitalacquired, or ventilatorassociated. The mortality of patients with aspiration pneumonia was higher than that of those without table 2.
Challenges remain in distinguishing aspiration pneumonia from chemical pneumonitis. Falcone and colleagues demonstrated that a sofa score of more than 5 or. Aspiration pneumonia refers to the pulmonary consequences of the abnormal entry of fluid, particulate exogenous substances, or endogenous secretions into the. Aspiration pneumonia is an important cause of serious morbidity and mortality, particularly among children with chronic medical conditions.
Diagnosis is based on clinical signs or symptoms of pneumonia in a person with a history or risk factors for aspiration. Role of aspiration pneumonia as a prognostic factor. Aspiration pneumonia treatment algorithm bmj best practice. The primary exposure was pneumonia type, classified as aspiration or nonaspiration. Aspiration pneumonitis and pneumonia pulmonary disorders. The infectious pulmonary process that occurs after abnormal entry of fluids into the lower respiratory tract is termed as aspiration pneumonia. The 2011 infectious diseases society of america idsa guidelines for. A retrospective study of 27 455 hospitalized children aged 1 to 18 years with ni diagnosed with pneumonia from 2007 to 2012 at 40 childrens hospitals in the pediatric health information system database.
Hospitalacquired pneumonia and ventilatorassociated. What is the initial treatment of aspiration pneumonia. Pdf aspiration pneumonitis and aspiration pneumonia are clinical syndromes caused by aspiration. The germs from food particles, saliva, vomit, or other substances may infect the. Aspiration pneumonia is often suspected if symptoms develop soon after a precipitating event, such as severe vomiting, exposure to general anesthesia or industrial fumes, or a tonicclonic seizure. Treatment hemodynamically stable patients with aspiration events o antibiotics are not warranted, and supportive care is the mainstay of therapy. Aspiration pneumonia is a common diagnosis in canine patients and can occur secondary to various underlying predisposing factors and conditions. Characteristics of children hospitalized with aspiration.
The usual site for an aspiration pneumonia is the apical and posterior segments of the lower lobe of the right lung. Diagnosis is based on clinical presentation and chest xray findings. Furthermore, despite the difference in treatment approaches for managing aspiration pneumonitis and aspiration pneumonia, these two. These factors included debilitation, impaired consciousness including general anesthesia, esophageal and neurologic disorders, cardiac resuscitation, and the presence of a nasogastric tube or tracheostomy. Aspiration pneumonitis and pneumonia clinical gate. Antibacterial treatment of aspiration pneumonia in older.
The purpose of this document is to guide the appropriate treatment of adult patients presenting with pneumonia. The term aspiration pneumonitis refers to inhalational acute lung injury that occurs after aspiration of sterile. Overview 11012016 communityacquired pneumonia in adults. Aspiration pneumonia and pneumonitis australian prescriber. Aspiration pneumonia is an inflammation of the lungs and bronchial tubes caused by inhaling foreign material, usually food, drink, vomit, or secretions from the mouth into the lungs. For example, aspiration pneumonia is a lung infection that causes inflammation and buildup of fluid.
A history suggesting recent foreign body aspiration within the past 12 days is of greatest value for a diagnosis of aspiration pneumonia. Are antibiotics indicated for the treatment of aspiration pneumonia. Aspiration pneumonia is an infection that may occur if a person breathes something in instead of swallowing it. Aspiration pneumonia is a lung infection caused by inhaled oral or gastric contents. Aspiration and nonaspiration pneumonia in hospitalized. Patients who have aspirated gastric material may present with dramatic signs and symptoms. Aspiration of larger amounts, or aspiration in a patient with impaired pulmonary defenses, often causes pneumonia andor a lung abscess. Aspiration that has resulted in pneumonia, lung abscess, or empyema caused by oropharyngeal anaerobic bacteria has usually been treated, at least initially, with penicillin. Community acquired pneumonia in adults, despite aspiration pneumonia being common in these. If the patient is supine then the aspirated material may also enter the posterior segment of the upper lobes.
Aspiration pneumonia is a lung infection that develops after you aspirate inhale food, liquid, or vomit into your lungs. Overview of aspiration pneumonia respiratory system. Aspiration pneumonitis and pneumonia are caused by inhaling toxic substances, usually gastric contents, into the lungs. List of aspiration pneumonia medications 34 compared. Some include chemical induced inflammation of the lungs as a subtype, which occurs from acidic but non. Antimicrobials are the gold standard for treatment of aspiration pneumonia. Ws risk factors, including recumbent position, gerd, and vomiting, as well as the abrupt onset of symptoms with prominent dyspnea, the nurse suspects aspiration pneumonia. However, in a critically ill patient with this syndrome, therapy should usually begin with penicillin 2 million u iv every 4 hours and metronidazole 750 mg iv every 6 hours. Falcone and colleagues demonstrated that a sofa score of more than 5 or 5. Clinical presentation aspiration may be clinically silent, or it may present with dyspnea, cough, o. The most important syndromes include aspiration pneumonitis, or.
You can also aspirate food or liquid from your stomach that backs up into your esophagus. Pdf aspiration pneumonias occur more frequently than reported and, in many cases, the. Elderly patients tend to aspirate because of conditions associated with aging that alter consciousness, such as sedative use and disorders eg, neurologic disorders, weakness. Aspiration pneumonia virginia department of behavioral. Pulmonary sequelae depend upon the volume and contents of the inoculum. Aspiration is a common event even in healthy individuals and usually resolves without detectable sequelae. Pdf pneumonitis and pneumonia after aspiration researchgate.
Article pdf available in cleveland clinic journal of medicine 779. Typical causes of pneumonia are influenza a, b, avian. Backgrounds aspiration pneumonia is a dominant form of communityacquired and healthcareassociated pneumonia, and a leading cause of death among ageing populations. Aspiration pneumonia diagnosis and treatment treatment for aspiration pneumonia depends on how severe the pneumonia is and how ill the individual was before the onset of aspiration pneumonia. Persistent aspiration pneumonia is often due to anaerobes and it may progress to lung abscess or even bronchiectasis. Aspiration pneumonia is a type of lung infection that is due to a relatively large amount of material from the stomach or mouth entering the lungs. Sensitive tests show that at least onehalf of healthy adults aspirate during sleep. Prophylactic antimicrobial therapy for patients with acute aspiration. Pdf rehabilitative management for aspiration pneumonia.
The term aspiration pneumonitis refers to inhalational acute lung injury that occurs after aspiration of sterile gastric contents. However, most episodes of aspiration cause minor symptoms or pneumonitis rather than infection or obstruction, and some patients aspirate with no sequelae. Healthcareassociated pneumonia and aspiration pneumonia. Prophylactic antimicrobial therapy for acute aspiration pneumonitis. In contrast to chemical pneumonitis, antibiotics are the most important component in the treatment of aspiration pneumonia. If you are not able to cough up the aspirated material, bacteria can grow in your lungs and cause an infection. Aspiration can cause lung inflammation chemical pneumonitis, infection bacterial pneumonia or lung abscess, or airway obstruction. Pdf aspiration pneumonia pathophysiological aspects, prevention. Aspiration pneumonia symptoms, diagnosis and treatment bmj. Aspiration is defined as the misdirection of oropharyngeal or gastric contents into the larynx and lower respiratory tract. If pulse oximetry and cardiac monitoring do not indicate the necessity for full intubation with a breathing machine, the patient will receive supplemental oxygen through a.
Aspiration pneumonia symptoms, diagnosis and treatment. Aspiration pneumonia the causative agents in aspiration pneumonia have shifted from anaerobic to aerobic bacteria. In hospital acquired aspiration pneumonia, the symptoms of cough. Aspiration pneumonia was found to be a significant prognostic factor in multivariable analyses by falcone et al.
Early empirical treatment is required for cases that are severe enough to warrant hospitalisation. Signs and symptoms often include fever and cough of relatively rapid onset. There may be gastric material in the oropharynx as well as wheezing. Aspiration pneumonia can lead to the development of necrotizing pneumonia or lung abscess, which may require a prolonged course of antibiotics and surgery.