Aspiration Pneumonia

What is Aspiration Pneumonia? 

Aspiration pneumonia is a constellation of the inhalation of fluids, food or food products, saliva, stomach acid, or secretions that is aspirated into one’s lungs, otherwise known as the lower respiratory tract. As a result of such products in one’s lungs, bacteria can be entered. In turn, pneumonia can result. Aspiration pneumonia often occurs due to the decrease in the immune system’s defense resulting in poorer clearance of oropharyngeal secretions. 

What are the risk factors and causes of Aspiration Pneumonia? 

There are various factors that can predispose one to acquire aspiration pneumonia. These include:

  • Incompetent lower esophageal sphincter or cough reflex, 
  • Malignancies, neurological disorders
  • Esophageal disorders
  • Impaired consciousness
  • Stroke
  • Altered mental status
  • Dental issues
  • Anesthesia
  • Dementia
  • Alcoholism 
  • Swallowing dysfunction

What are the signs and symptoms of Aspiration Pneumonia?

 Signs and symptoms include:

  • Wheezing
  • Fatigue
  • Chest pain
  • Productive or non-productive cough with a foul odor
  • Sputum or phlegm
  • Shortness of breath
  • Hoarseness of voice
  • Confusion
  • Difficulty swallowing
  • Malodorous breath

How is Aspiration Pneumonia diagnosed? 

Aspiration pneumonia is diagnosed clinically as well as through radiologic imaging. Clinically, certain signs that would allude to the diagnosis include fever, hypoxemia, dyspnea, and crackles upon auscultation. Through imaging, bilateral infiltrates are noted on both sides of one’s lungs. The site of aspiration is dependent upon the patient’s position at the time of aspiration, however, the right lower lobe is most commonly affected due to the branching position of the right mainstem bronchus. In addition, a bronchoscopy can be utilized. Blood work is also obtained to note any potential infection identifiers. To isolate the specific bacteria, sputum cultures can be acquired. 

How is Aspiration Pneumonia treated?

Aspiration pneumonia is treated with antibiotics, however, the antibiotic utilized is dependent upon whether the aspiration pneumonia was acquired inside or outside of a hospital. For aspiration pneumonia obtained in the hospital, Vancomycin and piperacillin-tazobactam are often implemented to ensure coverage of gram-negative bacteria as well as S. aureus. For aspiration pneumonia that is community-acquired, the antibiotics utilized include ampicillin-sulbactam, metronidazole, and amoxicillin. Often, upon receipt of sputum cultures, the antibiotics are then narrowed to cover the specific bacteria. In addition, positioning of the patient is modified by raising the head of the bed. Sometimes, the suction of the secretions may be necessary. Lastly, oxygen is administered to combat the hypoxic state a patient may be in. 

How can Aspiration Pneumonia be prevented? 

Aspiration pneumonia can be prevented through the implementation of proper oral hygiene, avoidance of certain medications that alter one’s oral care, and various techniques during feeding to avoid the risk of aspiration pneumonia. In addition, the monitoring and correction of certain underlying conditions is imperative to try and minimize the risk of aspiration pneumonia. These include the proper management of COPD, CHF, swallowing disorders, polypharmacy, and one’s nutritional status. Furthermore, the patients who may be at risk for aspiration pneumonia can take certain precautions. These include sitting upright while consuming food, drinking liquids that have been thickened, maintaining proper care of dentition and oral cavity, discontinuing smoking, and possibly engaging with a speech pathologist. With the proper management of such underlying and potentially threatening conditions, the risk of acquiring aspiration pneumonia can be significantly reduced. 

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