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Aspiration Pneumonia

Aspiration Pneumonias

Aspiration pneumonia is a bronchopneumonia resulting from the inhalation or inappropriate passage of foreign solid or liquid material into the respiratory tract.


Presentation

Aspiration pneumonia and pneumonitis presents from mildly ill to critically ill along with the signs and symptoms of septic shock and respiratory failure.

Physical Examination: The findings of the physical examination depend on the severity of the disease and the presence of complications. Aspiration pneumonia shows the following signs: fever, tachypnea, tachycardia, decrease in breath sounds, rales, hyporexia, and/or hypotension.

Host Factors: The decreased ability to protect the airway of the host results from previous cerebro-vascular accident (CVA), esophageal diseases, esophageal web, or if the patient is chronically fed by feeding tube.

Chemical pneumonia

The physical symptoms of this type of pneumonia range from tachypnea, tachycardia, wheezing or cyanosis.

Bacterial pneumonia

The clinical presentation of bacterial aspiration pneumonia includes nonspecific symptoms such as headache or nausea/vomiting, and weight loss. Fever, absence of rigors, chest pain, chills and cough with sputum are some of the other symptoms manifested by the patients [7].

Fever
  • However, the results indicated that dyspnea, fever, deterioration of general functioning, tachypnea and crepitation with auscultation are characteristics of some importance and that at least two or three characteristics should be present.[ncbi.nlm.nih.gov]
  • In this report, a 40-year-old woman who took liquid propolis for relief of her common cold experienced severe sore throat, dysphagia, and easy choking followed by fever and chills.[ncbi.nlm.nih.gov]
  • The management of poststroke dysphagia is multidisciplinary with nurses playing a key role in screening for dysphagia risk, monitoring tolerance of food and fluids and checking for the development of complications such as fever, dehydration and change[ncbi.nlm.nih.gov]
  • Fever, absence of rigors, chest pain, chills and cough with sputum are some of the other symptoms manifested by the patients.[symptoma.com]
  • Signs and symptoms often include fever and cough of relatively rapid onset. Complications may include lung abscess.[en.wikipedia.org]
Epilepsy
  • Epilepsy. Coma. Critical illnesses and debilitated patients. Gastroesophageal reflux disease (GERD). Iatrogenic – anesthesia (general), bronchoscopy, endoscopy (upper gastrointestinal), intubation (nasogastric or endotracheal). tracheostomy.[healthhype.com]
Cough
  • We present a case of a female who presents with weight loss, cough and radiological findings of aspiration pneumonia and achalasia. A discussion of mechanisms for this association are presented.[ncbi.nlm.nih.gov]
  • The aspiration pneumonia probably had multifactorial etiology: dysphagia, abnormal cough reflex, colonization of the oropharynx by virulent bacteria, etc. No aspiration pneumonia occurred after medical treatment and rehabilitation had been started.[ncbi.nlm.nih.gov]
  • All had a history of cough after oral rinsing and two of them experienced sudden brief desaturation in the days before ICU referral. Two of these patients, both in allogeneic bone marrow transplant setting, died.[ncbi.nlm.nih.gov]
  • People with COPD do have strong coughs, but as their immune system weakens with age, it becomes less able to fight off infection.[healthcommunities.com]
  • Clinical presentation included persistent coughing, tachypnoea, recurrent febrile illness and chest infections. The pulmonary radiological picture was mainly right middle lobar and perihilar infiltrates.[ncbi.nlm.nih.gov]
Dyspnea
  • However, the results indicated that dyspnea, fever, deterioration of general functioning, tachypnea and crepitation with auscultation are characteristics of some importance and that at least two or three characteristics should be present.[ncbi.nlm.nih.gov]
  • Symptoms and Signs Symptoms and signs include Cough Fever Dyspnea Chest discomfort Chemical pneumonitis caused by gastric contents causes acute dyspnea with cough that is sometimes productive of pink frothy sputum, tachypnea, tachycardia, fever, diffuse[merckmanuals.com]
  • In the absence of an obvious predisposition, the abrupt onset of a self-limited illness characterized by dyspnea, cyanosis, and low-grade fever associated with diffuse rales, hypoxemia, and alveolar infiltrates in dependent lobes should suggest aspiration[ncbi.nlm.nih.gov]
  • Symptoms include cough and dyspnea. Diagnosis is based on clinical presentation and chest x-ray findings. Treatment and prognosis differ by aspirated substance.[msdmanuals.com]
  • ., tachypnea, dyspnea, tachycardia). Mucus production is also increased, which can obstruct airflow and further decrease gas exchange.[quizlet.com]
Tachypnea
  • However, the results indicated that dyspnea, fever, deterioration of general functioning, tachypnea and crepitation with auscultation are characteristics of some importance and that at least two or three characteristics should be present.[ncbi.nlm.nih.gov]
  • Chemical pneumonia The physical symptoms of this type of pneumonia range from tachypnea, tachycardia, wheezing or cyanosis.[symptoma.com]
  • ., tachypnea, dyspnea, tachycardia). Mucus production is also increased, which can obstruct airflow and further decrease gas exchange.[quizlet.com]
  • Both aspiration pneumonia and pneumonitis can present with the following: Fever or hypothermia Tachypnea Tachycardia Decreased breath sounds Dullness to percussion over areas of consolidation Rales Egophony and pectoriloquy Decreased breath sounds Pleural[web.archive.org]
  • Symptoms and Signs Symptoms and signs include Cough Fever Dyspnea Chest discomfort Chemical pneumonitis caused by gastric contents causes acute dyspnea with cough that is sometimes productive of pink frothy sputum, tachypnea, tachycardia, fever, diffuse[merckmanuals.com]
Rales
  • In the absence of an obvious predisposition, the abrupt onset of a self-limited illness characterized by dyspnea, cyanosis, and low-grade fever associated with diffuse rales, hypoxemia, and alveolar infiltrates in dependent lobes should suggest aspiration[ncbi.nlm.nih.gov]
  • Aspiration pneumonia shows the following signs: fever, tachypnea, tachycardia, decrease in breath sounds, rales, hyporexia, and/or hypotension.[symptoma.com]
  • Both aspiration pneumonia and pneumonitis can present with the following: Fever or hypothermia Tachypnea Tachycardia Decreased breath sounds Dullness to percussion over areas of consolidation Rales Egophony and pectoriloquy Decreased breath sounds Pleural[web.archive.org]
  • Productive cough Shortness of breath Fever (sometimes) Chest pain Patients with aspiration pneumonia may also exhibit with the following signs : Rapid breathing (tachypnea) Rapid heart rate (tachycardia) Abnormal breathing sounds (rales, wheezing, whispering[healthhype.com]
  • Findings on physical examination may include tachypnea, tachycardia, fever, rales, wheezing, and possibly cyanosis.[emedicine.com]
Purulent Sputum
  • It produces fever, leukocytosis, purulent sputum, and an infiltrate visible on a radiograph. It is not an infectious but an inflammatory process, because the low gastric pH keeps the gastric contents sterile.[cid.oxfordjournals.org]
  • Purulent sputum. Signs may include tachycardia, tachypnoea, decreased breath sounds and dullness to percussion over areas of consolidation, pleural friction rub. Severe infection may lead to hypoxia and septic shock.[patient.info]
  • The patient may also describe the following: Cough with purulent sputum Fever or chills Malaise, myalgias Rigors may be present or absent Shortness of breath, dyspnea on exertion Pleuritic chest pain Putrid expectoration (a clue to anaerobic bacterial[emedicine.com]
  • sputum •Dyspnea (shortness of breath) •Pleuritic chest pain 4.Has at least TWO of the following abnormal vital signs: •Fever or hypothermia documented by the investigator (temperature 38.0 C or 36.0 C ) •Hypotension with systolic blood pressure (SBP)[clinicaltrialsregister.eu]
Vomiting
  • A washout period should be considered when switching between ChE inhibitors to minimize the risk of vomiting and aspiration.[ncbi.nlm.nih.gov]
  • METHODS: In this retrospective cohort study, 331 patients with AP having oral food intake in premorbid status were included after exclusions for reasons such as vomiting or respiratory insufficiency.[ncbi.nlm.nih.gov]
  • Inhalation of vomit can occur when a person who vomits is not completely awake, as can happen after a seizure or a drug or alcohol overdose or when a person awakens from anesthesia.[msdmanuals.com]
  • Sometimes foods, liquids, or vomited stomach contents may accidentally get into these airways. Inhaling can move these substances further into the lungs. This is called aspiration.[health.cvs.com]
  • The history may include such details as excessive vomiting, chronic regurgitation, generalized musculoskeletal weakness, or a recent episode of anesthesia. Most patients present with acute dyspnea, fever, coughing and lethargy.[bluepearlvet.com]
Nausea
  • Cholinesterase (ChE) inhibitors approved for treatment of Alzheimer disease are associated with nausea and vomiting in a sizable percentage of patients, ranging from 5% to 31% in clinical trials.[ncbi.nlm.nih.gov]
  • Bacterial pneumonia The clinical presentation of bacterial aspiration pneumonia includes nonspecific symptoms such as headache or nausea/vomiting, and weight loss.[symptoma.com]
  • […] pneumonia is similar to that of community-acquired pneumonia and may include the following: Cough Fever or chills Malaise, myalgias Shortness of breath, dyspnea on exertion Pleuritic chest pain Putrid expectoration Nonspecific symptoms including headache, nausea[web.archive.org]
  • Presentation Nonspecific symptoms - eg, fever, headache, nausea, vomiting, anorexia, myalgia, weight loss. Cough. Dyspnoea. Pleuritic chest pain. Purulent sputum.[patient.info]
Choking
  • This study aimed to determine the frequency of reporting of AP or choking as a cause of death on death certificates with mention of stroke in the United States as a proxy measure of the incidence of dying from AP or choking among patients with stroke.[ncbi.nlm.nih.gov]
  • With regard to considering aspiration pneumonia in nursing home residents with pneumonia, final consensus was reached about the risk indicators dysphagia, choking incident, (history of) tube feeding, neurological disease and cognitive impairment.[ncbi.nlm.nih.gov]
  • In this report, a 40-year-old woman who took liquid propolis for relief of her common cold experienced severe sore throat, dysphagia, and easy choking followed by fever and chills.[ncbi.nlm.nih.gov]
  • She began choking and coughing immediately after surgery. She was diagnosed with aspiration pneumonia based on chest radiography and computed tomography findings.[ncbi.nlm.nih.gov]
  • […] aspiration of foreign material over a prolonged time o Zenker’s diverticulum o Achalasia o TE fistula o Neuromuscular diseases o Chronic reflux o Lipoid pneumonia § Mineral oil (used as a laxative) § Oily nose drops (not used anymore) · Clinical findings o Choking[learningradiology.com]
Loss of Appetite
  • […] of appetite Coughing, with or without phlegm Your Legal Rights Since the elderly population has an increased risk of developing aspiration pneumonia, many victims and loved ones might not understand that they have legal recourse and write it off as a[medmalfirm.com]
  • […] of appetite Excessive fatigue Bluish skin ( cyanosis ) Nausea Vomiting Diarrhea Joint pain ( arthralgia ) Muscle aches ( myalgia ) Rapid heartbeat Dizziness or lightheadedness In the elderly [ edit ] New or worsening confusion Hypothermia Poor coordination[en.wikipedia.org]
Tachycardia
  • Chemical pneumonia The physical symptoms of this type of pneumonia range from tachypnea, tachycardia, wheezing or cyanosis.[symptoma.com]
  • Both aspiration pneumonia and pneumonitis can present with the following: Fever or hypothermia Tachypnea Tachycardia Decreased breath sounds Dullness to percussion over areas of consolidation Rales Egophony and pectoriloquy Decreased breath sounds Pleural[web.archive.org]
  • ., tachypnea, dyspnea, tachycardia). Mucus production is also increased, which can obstruct airflow and further decrease gas exchange.[quizlet.com]
  • Signs may include tachycardia, tachypnoea, decreased breath sounds and dullness to percussion over areas of consolidation, pleural friction rub. Severe infection may lead to hypoxia and septic shock.[patient.info]
Cyanosis
  • In the absence of an obvious predisposition, the abrupt onset of a self-limited illness characterized by dyspnea, cyanosis, and low-grade fever associated with diffuse rales, hypoxemia, and alveolar infiltrates in dependent lobes should suggest aspiration[ncbi.nlm.nih.gov]
  • Chemical pneumonia The physical symptoms of this type of pneumonia range from tachypnea, tachycardia, wheezing or cyanosis.[symptoma.com]
  • Pink-colored to red sputum (hemoptysis) Bluish tinge of the lips, fingers and/or toes (cyanosis) Causes Aspiration pneumonia is unlikely to arise in a healthy person who is conscious and has properly functioning gag and cough reflexes.[healthhype.com]
  • Findings on physical examination may include tachypnea, tachycardia, fever, rales, wheezing, and possibly cyanosis.[emedicine.com]
  • […] accompanied by sweating, chills and shivering Sharp, stabbing chest pains Rapid, shallow, often-painful breathing Less-common symptoms [ edit ] Coughing up blood ( hemoptysis ) Headaches, including migraines Loss of appetite Excessive fatigue Bluish skin ( cyanosis[en.wikipedia.org]
Periodontitis
  • The NHANES III data demonstrate that dental caries and periodontal diseases occur with substantial frequency and represent a burden of unmet treatment need in older adults.[ncbi.nlm.nih.gov]
  • Periodontal diseases play an evident role in the etiology of aspiration pneumonia due to their effect to alter the oral bacterial flora.[hungary.pure.elsevier.com]
  • Abstract The primary problems that predispose to aspiration pneumonia include a reduced level of consciousness, dysphagia, periodontal disease, and mechanical interference that is related to the insertion of various tubes into the respiratory or gastrointestinal[academic.oup.com]
  • Other: tracheo-oesophageal fistula, ventilator-associated pneumonia, periodontal disease, gastro-oesophageal reflux [ 4 ] , post-gastrectomy, tracheostomy.[patient.info]
  • Other: tracheo-oesophageal fistula, ventilator-associated pneumonia, periodontal disease, gastro-oesophageal reflux [ 4 ], post-gastrectomy, tracheostomy.[patient.info]
Dental Caries
  • The NHANES III data demonstrate that dental caries and periodontal diseases occur with substantial frequency and represent a burden of unmet treatment need in older adults.[ncbi.nlm.nih.gov]
  • Dental caries are mainly caused by cariogenic streptococci and lactobacilli. In the case of serious periodontal diseases, anaerob parodonto-pathogen microorganisms play the major role.[ncbi.nlm.nih.gov]
Headache
  • Bacterial pneumonia The clinical presentation of bacterial aspiration pneumonia includes nonspecific symptoms such as headache or nausea/vomiting, and weight loss.[symptoma.com]
  • […] aspiration pneumonia is similar to that of community-acquired pneumonia and may include the following: Cough Fever or chills Malaise, myalgias Shortness of breath, dyspnea on exertion Pleuritic chest pain Putrid expectoration Nonspecific symptoms including headache[web.archive.org]
  • Presentation Nonspecific symptoms - eg, fever, headache, nausea, vomiting, anorexia, myalgia, weight loss. Cough. Dyspnoea. Pleuritic chest pain. Purulent sputum.[patient.info]
  • […] therapies for older adults -- Considering complementary & alternative medicines for older adults -- Managing misuse of alcohol & psychoactive prescription medications in older adults -- Assessing older adults for syncope following a fall -- Treating headaches[worldcat.org]
Confusion
  • They were more likely cared for in the intensive care unit (19% vs 13%, P   0.002), had longer unadjusted hospital length of stay (9 vs 7 days, P CONCLUSIONS: Among pneumonia patients, confusion, nursing home residence, and cerebrovascular disease are[ncbi.nlm.nih.gov]
  • Data on age, sex, body mass index, Mini Nutritional Assessment-Short Form score, Barthel Index score, Charlson Comorbidity Index score, and pneumonia severity (Japanese version of the CURB-65 (C (confusion), U (blood urea nitrogen 20 mg/dL), R (respiratory[ncbi.nlm.nih.gov]
  • Signs and Symptoms of Aspiration Pneumonia There are several signs and symptoms associated with aspiration pneumonia, yet not all victims will show signs of every symptom: Confusion and disorientation Fever Wheezing and/or noisy breathing Shortness of[medmalfirm.com]
  • -Confusion/stupor may be only finding -Hypothermia Non-specific findings: diaphoresis, anorexia, fatigue, myalgias, HA, and abd pain -H&P examination -CXR -Gram stain of sputum -Sputum C&S -Pulse ox and/or ABGs -CBC (WBCs), WBC diff -Blood cultures -Sputum[quizlet.com]
  • […] cancers -- Depression & other mental health issues -- Sexual health & dysfunction -- Common infections -- Pressure ulcers -- Common skin disorders -- Sleep disorders -- Oral diseases & disorders -- Common clinical scenarios in geriatrics -- Evaluating confusion[worldcat.org]
Altered Mental Status
  • Additionally, altered mental status on emergency department arrival, white blood cell count, and increased exposure duration were independently associated with the development of aspiration pneumonia. Copyright 2017 Elsevier Inc. All rights reserved.[ncbi.nlm.nih.gov]
  • It commonly occurs in patients with altered mental status who have an impaired gag or swallowing reflex. Treatment is directed to the infectious agent or underlying cause.[patientslikeme.com]
  • It commonly occurs in patients with altered mental status who have an impaired gag or swallowing reflex. The bacteriology and presentation of aspiration pneumonia have changed over the past five decades.[bestpractice.bmj.com]
Agitation
  • Pacemakers, Defibrillators, and Cardiac Resynchronization Devices in Hospital Medicine -- Section 2: Critical Care -- Chapter 137: Inpatient Cardiac Arrest and Cardiopulmonary Resuscitation -- Chapter 138: Acute Respiratory Failure -- Chapter 139: Pain, Agitation[worldcat.org]
  • Airway Management -- Chapter 147: Hemodynamic and Respiratory Monitoring in Acute Respiratory Failure -- Chapter 148: Principles of Mechanical Ventilation -- Chapter 149: Nutrition in Pulmonary Disease -- Chapter 150: Diagnosis and Treatment of Pain, Agitation[worldcat.org]
Stupor
  • -Confusion/stupor may be only finding -Hypothermia Non-specific findings: diaphoresis, anorexia, fatigue, myalgias, HA, and abd pain -H&P examination -CXR -Gram stain of sputum -Sputum C&S -Pulse ox and/or ABGs -CBC (WBCs), WBC diff -Blood cultures -Sputum[quizlet.com]

Workup

From the data obtained from the radiographic evidence of an infiltrate, the diagnosis of aspiration pneumonia can be ascertained. The exact location of the infiltrate is determined by the chest radiograph. Laboratory studies are guided by the symptoms and clinical presentation of the patients.

  • CBC with Differential: This test reveals the levels of white blood cells (WBCs). In bacterial and chemical pneumonia, there is an increase in the levels of neutrophils, and thrombocytosis
  • Chest Radiography: This test helps to ascertain the exact location of the aspiration pneumonia. 
  • CT Scanning: Though this test is not needed in all the types of aspiration pneumonia, the technique can help to characterize pleural effusions. It helps to differentiate between the pulmonary and pleural abnormalities.
  • Ultrasonography also helps to locate the exact position of the pleura effusions.
  • Bronchoscopy: This procedure is indicated in patients with chemical pneumonia when the foreign material is suspected.
Pulmonary Infiltrate
  • Aspiration pneumonia is defined as pulmonary infiltration caused by inhaled material, either solid or liquid, that is inherently toxic or that initiates a toxic response.[ncbi.nlm.nih.gov]
  • For infants and children in this area who present with persistent pulmonary infiltrates which are not responsive to antimicrobials, the differential diagnosis of not only animal fat (ghee, clarified butter) but also of olive oil lipoid pneumonia must[ncbi.nlm.nih.gov]
  • Increasing age, the need for intraoperative blood component transfusion and bilateral pulmonary infiltrates are independent risk factors for fatal outcome after aspiration pneumonia.[ncbi.nlm.nih.gov]
  • This practice is believed to lead to the selection of more resistant organisms. [22] In addition, those patients with recent aspiration, fever, and leukocytosis should not be treated even in the presence of a pulmonary infiltrate due to the risk of development[emedicine.com]
  • infiltrate(s) on chest X-ray (CXR) or chest computed tomography (CT) scan consistent with acute bacterial pneumonia within 24 hours prior to the first dose of test article. 7.Has disease categorized as being PORT Risk Class II, III, or IV at Screening[clinicaltrialsregister.eu]
Atelectasis
  • Aspiration of particulate matter causes airways obstruction and atelectasis. Most commonly there is a shifting mixed infiltrate in the lower lobes.[ncbi.nlm.nih.gov]
  • […] antipyretics, fever, analgesics (chest pain), antiemtic (gerd,proton pump inhibitor) -Pleurisy (Inflammation of the tissues that line the lungs and chest cavity) -Pleural effusion (A buildup of fluid between the tissues that line the lungs and the chest) -Atelectasis[quizlet.com]
  • Gastric acid causes a chemical burn of the airways and lungs, leading to rapid bronchoconstriction, atelectasis, edema, and alveolar hemorrhage.[merckmanuals.com]

Treatment

Antibiotics: In aspiration pneumonia, antibiotics form the first line in the management procedure. The important points to consider while administering antibiotics in patients with aspiration pneumonia are as follows:

  • If the pneumonitis fails to resolve within 48 hours, antibiotics must be administered.
  • Patients with small-bowel obstruction must receive antibiotics.
  • Patients who are on antacids must be considered for antibiotic therapy since there is an increase in the chances of gastric colonization.
  • The choice of antibiotics range ceftriaxone plus azithromycin, levofloxacin, or moxifloxacin, Piperacillin/tazobactam and imipenem or cilastatin along with vancomycin.
  • Other antibiotics that can be used to manage the condition include a third-generation cephalosporin with a macrolide or a fluoroquinolone alone [8].

Managing Chemical Aspiration Pneumonia: Important step for the management of chemical pneumonia is maintaining the airways of the secretions by tracheal suctioning and oxygen supplementation. The routine use of corticosteroid must be avoided.

Prognosis

Prognosis of the bacterial and chemical pneumonia depends on the underlying diseases or complications as well as host status. If the bacterial pneumonia is not treated, it can lead to severe complications such as lung abscess and bronchopleural fistula. Longer period of hospitalization is associated with nosocomial pneumonia [6].

Complications

The common complications of aspiration pneumonia are lung abscess, shock, bacteremia, and respiratory failure.

Etiology

Three different types of materials cause three different types of aspiration pneumonia. They are as follows:

  • Chemical pneumonia: Aspiration of the gastric acid cause chemical pneumonia (infectious form) or pneumonitis (or chemical injury).
  • Bacterial pneumonia: When the aspiration of bacteria from oral areas causes pneumonia, it is called bacterial pneumonia. Sometimes there is aspiration of some foreign bodies which may predispose patients with this type of pneumonia.
  • Exogenous lipoid pneumonia: Aspiration of the oil causes this rare form of pneumonia.

Though aspiration pneumonia includes chemical and bacterial pneumonia, their presentation, pathophysiology and treatment vary [2].

Epidemiology

The authentic data for chemical pneumonia is not known, some studies, however, suggest that around 5 to 15% of all the community acquired pneumonia (CAP) results from aspiration pneumonia. The 30-day mortality rate of the aspiration pneumonia was found to be around 21%.

It has been estimated that 1 in every 10 patient hospitalized post drug-overdose were found to have aspiration pneumonitis.

Nosocomial bacterial pneumonia is more common among males than females. Adults were found to be more frequently affected by this disease than the children. The predisposing factors are common among the elderly, making them susceptible to this disease [3].

Sex distribution
Age distribution

Pathophysiology

In patients who develop aspiration pneumonia, the infiltrate increases the risk of oropharyngeal aspiration. The risk is greatly increased in patients with the lower level of consciousness. The three most important determinants of the severity and extent of aspiration pneumonia are nature, and volume of the material aspirated, along with the host defenses.

Chemical pneumonia: This aspiration leads to acute respiratory distress within one hour. The chances of development of this type of pneumonia depend on the levels of consciousness. Since the gastric fluid is acidic in nature, it results in chemical burns. Studies have revealed that if the pH of the aspirated fluid is less than 2.5 and volume aspirated is greater than 0.3 mL/kg of body weight, the chances of chemical pneumonia increase several fold.

Bacterial pneumonia: In persons with impaired airway defense, there is an increased risk of bacterial pneumonia as the inherent mechanism of removing the bacteria is compromised. This type of pneumonia occurs both in community and hospital acquired pneumonia. Anaerobic and micro-aerophilic organisms are believed to play significant role in this disease

Causative microorganisms: The common causative micro-organisms of community acquired aspiration pneumonia are: Streptococcus species (pneumoniae, aureus), Haemophilus influenzae, and Enterobacteriaceae. However, the hospital acquired pneumonia (especially intubated patients) is caused by gram-negative organisms such as Pseudomonas aeruginosa [4] [5].

Prevention

  • Patients with swallowing dysfunction must opt for soft diet.
  • Lower risk is associated with patients who use the gastrostomy tubes along with mosapride citrate.
  • Patients with altered consciousness who are at the risk of aspiration pneumonia must be positioned in a semi-recumbent position [9] [10].

Summary

When the gastric contents or oropharyngeal contents seek passage to the lower airways, it is defined as aspiration.

The passage of the foreign materials to the lungs may cause several syndromes depending on the nature, frequency, host factors and quantity of the material aspirated. Pneumonia that accompanies aspiration is called aspiration pneumonia [1].

Patient Information

Aspiration pneumonia is a serious disease and there are certain conditions that can worsen or increase the chances of complications such as alcoholism, drug overdose, stroke and seizures, trauma to head, dysphagia, esophageal neoplasm, gastroesophageal reflux disease, myasthenia gravis, Parkinson disease and dementia.

Critical illness and use of mechanical devices also contribute to the disease. Hence, awareness of the condition in such patients is advisable.

References

Article

  1. Marik PE. Aspiration pneumonitis and aspiration pneumonia. N Engl J Med. Mar 1 2001;344(9):665-71.
  2. Varkey B, Kutty K. Pulmonary aspiration syndromes. In: Kochar's Concise Textbook of Medicine.Baltimore, Md:. Lippincott Williams & Wilkins;1998:902-906.
  3. Lanspa MJ, Jones BE, Brown SM, Dean NC. Mortality, morbidity, and disease severity of patients with aspiration pneumonia. J Hosp Med. Feb 2013;8(2):83-90. 
  4. Marik PE, Careau P. The role of anaerobes in patients with ventilator-associated pneumonia and aspiration pneumonia: a prospective study. Chest. Jan 1999;115(1):178-83. 
  5. Mier L, Dreyfuss D, Darchy B, Lanore JJ, Djedaïni K, Weber P, et al. Is penicillin G an adequate initial treatment for aspiration pneumonia? A prospective evaluation using a protected specimen brush and quantitative cultures. Intensive Care Med. 1993;19(5):279-84. 
  6. Lanspa MJ, Jones BE, Brown SM, Dean NC. Mortality, morbidity, and disease severity of patients with aspiration pneumonia. J Hosp Med. Feb 2013;8(2):83-90.
  7. Akritidis N, Gousis C, Dimos G, Paparounas K. Fever, cough, and bilateral lung infiltrates. Achalasia associated with aspiration pneumonia. Chest. Feb 2003;123(2):608-12.
  8. Moore FA. Treatment of aspiration in intensive care unit patients. JPEN J Parenter Enteral Nutr. Nov-Dec 2002;26(6 Suppl):S69-74; discussion S74.
  9. Vadeboncoeur TF, Davis DP, Ochs M, Poste JC, Hoyt DB, Vilke GM. The ability of paramedics to predict aspiration in patients undergoing prehospital rapid sequence intubation. J Emerg Med. Feb 2006;30(2):131-6. 
  10. Loeb MB, Becker M, Eady A, Walker-Dilks C. Interventions to prevent aspiration pneumonia in older adults: a systematic review. J Am Geriatr Soc. Jul 2003;51(7):1018-22. 

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Last updated: 2019-07-11 21:06