Pulmonology Dept.

Faculty of Medicine
University of Hasanuddin
ASPIRATION PNEUMONIA
IRAWATY DJ
The term Aspiration pneumonia condition in which a
radiographic infiltrate develops in setting of either a
witnessed episode of gross aspiration or risk factors for
aspiration
liquid, particle substantion, endogen secret
from upper airways or gastric contents

Aspiration pneumonia Vs Aspiration pneumonitis
Chemical injury to the lung related to volume & pH of
the aspirated material

Incidence
Half of all adults aspirate small amounts of
oropharyngeal contents while sleeping

Aspiration pneumonia may occur in up to 10% of
nursing home residents annually

Pneumonia can develop in patient with certain
underlying diseases that tend to impair host
defenses
Risk for aspiration
alteration in defense mechanism that protect lower
airway :
glottis closure
cough reflex
clearance mechanism

Aspiration material inflamation process
RISK FACTORS
Transient (general anaestesi, intoxication,
drug abuse)
Persistent ( neuromuskular
disorders/seizure, achalasia)

Normal flora in oral cavity (ginggival crevice)
anaerob pulmonary infection
Host Risk Factors
Underlying serious illness
Altered sensorium
Stroke
Dysphagia
Gastroesophageal reflux
Postgasterctomy
Xerostomia
Feeding tube
Periodontal disease
Altered consciousness

Drugs
Alcohol
CVA
Hepatic failure
Anesthesia
Esophageal disorders
GERD
Stricture
Tracheoesophageal fistula
Incompetent cardiac sphincter
Protracted vomiting
Disruption of glottic closure
Endotracheal intubation
NG tube
Endoscopy/bronchoscopy
Neuromuscular disorders
Multiple sclerosis
Parkinsons
Myasthenia gravis
Aspirate risk factors
Fluid pH << 2.5
Large particles
Large volume
Hypertonic fluid
Bacterial contamination
Fulminating anaerobic pneumonia, a 44-year-old woman with onset of pneumonia 6 days before admission. A.
Day of admission. Patchy consolidation in right lower lung field and behind the cardiac silhouette. B. One day
after admission: Extensive patchy alveolar infiltrates bilaterally with areas of rarefaction on right suggestive of
cavitation.
Gangrene of the lung after aspiration, anteroposterior (A)
and lateral (B ) views. Extensive cavitation
following necrotizing pneumonia.
Clinical Presentation


Most with classic anaerobic lung infection
cough, production of foul-smelling & purulent sputum,
fever

Significant risk factor for aspiration

Aspirated aerobic organisms present with the abrupt
onset of fever, purulent productive cough, hemoptysis,
chest pain


PREVENT ASPIRATION

a. Semirecumbent position or erect position
b. Volume decrease of gastric content
(metochlopramide or NG tube)
c. Prevent regurgitation
d. Netralisation gastric acid H2 blockers

TREATMENT
Optimal antimicrobial therapy
Supportive care ( IV Fluid, suction )
Complication management :
drainage abscess empyema
thoracic
Antimocrobial Therapy

Specimen for microbiologic examination
culture & sensitivity
Standard therapy penicillin
Alternatif : clindamycin, metronidazole +
penicillin, beta-lactam + anti beta-lactamase
inhibitor

Antimicrobial Therapy
Should be based on :
Assessment of the severity of illness
Where the infection was acquired
(community or hospital)
Presence or absence risk factors for Gram
negative colonization

Duration of therapy Depend on
Clinical presentation & CXR

Evaluation of
Fever
Sputum purulence
Abscess/complication

Solid Particle Aspiration
Large particles
Sudden respiratory distress, cyanosis,
aphonia
Heimlich!
Small particles
Irritative cough, unilateral wheezing
Remember: bacterial superinfection is common