Definitions

• Aspiration: Entry of Material into the Larynx and Lower Respiratory Tract
  • Includes Oropharyngeal Contents (Food/Drink) or Gastric Contents
• Aspiration (Chemical) Pneumonitis: Inflammatory Reaction in the Lower Airways in Response to Aspiration
  • Independent of Infection
  • Mediated by Inflammatory Cytokines (TNF-α and IL-8)
  • Mendelson’s Syndrome – Aspiration Pneumonitis that Occurs During Anesthesia, Particularly During Pregnancy
• Aspiration (Bacterial) Pneumonia: Acute Bacterial Infection Due to Aspiration
  • Most Common Site: Superior Segment of Right Lower Lobe (RLL)

Risk Factors

• Dysphagia
• Head, Neck, and Esophageal Tumors
• Esophageal Stricture
• Esophageal Motility Disorders
• COPD
• Seizures
• Degenerative Neurologic Disease (Multiple Sclerosis, Parkinson’s Disease, Dementia)
• Altered Mental Status
• Stroke
• Antipsychotic Medication
• Cardiac Arrest

Diagnosis

• Primary a Clinical Diagnosis (Based on Clinical History, Exam, and Chest X-Ray)
• Bronchoalveolar Lavage (BAL) May Be Used to Distinguish Pneumonia from Pneumonitis

Treatment

• Treatment: Primarily Supportive Therapy
• Antibiotics: Generally Only Indicated for Defined Pneumonia
  • Aspiration or Aspiration Pneumonitis Alone Do Not Require Prophylactic Antibiotic Therapy, Even if Radiographic Infiltrate Present
  • May Consider Empiric Antibiotic Treatment in Severe Cases
• Bronchoscopy: Not Routinely Required
  • Consider if a Large-Volume Aspiration was Witnessed with Concern for Particulate Matter in the Airway