Most cases will resolve…. Some of the symptoms of pneumonia may be manageable at home. This article covers home remedies for pneumonia and when to see a doctor. Learn more here. Pneumonia is an infection of the lung tissue that can make it difficult to breathe due to inflammation, fluid, and pus. In severe cases, it can be…. Pneumonitis is a condition where inhaling certain substances leads to an allergic reaction in the lungs.
Triggers include mold and dust, handling…. The way people experience pneumonia depends on their age and the type of pneumonia they have. Learn more here and find out how it compares with flu…. Everything you need to know about aspiration pneumonia. Medically reviewed by Elaine K. Luo, M. What is aspiration pneumonia? Is it fatal? Causes and risk factors Symptoms Diagnosis Treatment Complications Prevention Outlook Aspiration pneumonia is a type of pneumonia that might occur if a person breathes something in instead of swallowing it.
Share on Pinterest Germs in the lungs cause aspiration pneumonia. Image credit: Melvil, , November Can you die from aspiration pneumonia? Causes and risk factors. Share on Pinterest A high fever and difficulty breathing may indicate aspiration pneumonia. Share on Pinterest Seeing a doctor as soon as possible may prevent complications. Exposure to air pollutants may amplify risk for depression in healthy individuals. Costs associated with obesity may account for 3. Related Coverage.
What is Mycoplasma pneumoniae infection? Musher DM. Overview of pneumonia. Goldman-Cecil Medicine. Philadelphia, PA: Elsevier; chap Bacterial pneumonia and lung abscess. Murray and Nadel's Textbook of Respiratory Medicine. Philadelphia, PA: Elsevier Saunders; chap URAC's accreditation program is the first of its kind, requiring compliance with 53 standards of quality and accountability, verified by independent audit.
Learn more about A. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Copyright A. Consequently, the occurrence risk of pneumonia increases when aspiration occurs.
Terpenning et al. They identified the dental decay, presence of cariogenic bacteria, and periodontal pathogens as significant risk factors. One study observed oral cavities of elderly patients requiring long term care who contract aspiration pneumonia and described characteristic change like mucous membranes residues like oblate, coated tongue, or remaining roots after losing the crown portion.
These factors were also suggested as environmental factors that induce colonization of bacterial flora, which are not observed under healthy oral conditions [ 70 ]. Proton pump inhibitors and histamine receptor-2 antagonists change the acidic gastric environment and promote gastric colonization. Although these drugs do not increase the risk of gastric aspiration, they are strongly association with pneumonia [ 71 , 72 ]. Patients with risk factors for aspiration can be suspected of having aspiration in case they show acute symptoms such as coughing, choking, shortness of breath, cyanosis, tachypnea, tachycardia, speaking difficulty, and hoarseness [ 2 ].
Witnessed aspiration is evident by validating the presence of oral contents, food particles, pepsin, or bile in the trachea-bronchial tree or bronchoalveolar lavage fluid.
In patients with severe trauma, blood-containing aspirates can be observed [ 73 ]. Moreover, patients are diagnosed with either aspiration pneumonia or aspiration pneumonitis with subsequent bacterial infection in case of a bacteriologic evidence of an infection. Thus, the work of breathing increases and lung compliance decreases, leading to pulmonary hypertension or cor pulmonale [ 2 ]. However, one of the reasons for difficult diagnosis is unwitnessed aspiration or silent asymptomatic aspiration.
If lung injury is suspected without clear evidence of prior aspiration, the clinician is required to make a diagnosis by exclusion. Patients can be diagnosed with aspiration-induced lung injury if they exhibit risk factors for aspiration only after excluding other possible causes of hypoxia, such as pulmonary edema, pulmonary embolism, and community- or hospital-acquired pneumonia.
Such diagnosis is possible if patients show radiographic evidence of infiltrate in dependent bronchopulmonary segment [ 5 , 74 ]. When the patient is in a recumbent position, the dependent pulmonary segments are the posterior segments of the upper lobes and apical segments of the lower lobes.
During walking or in a semi-recumbent position, the basal segments of lower lobes are mainly involved [ 5 , 75 ]. Another challenge is to distinguish between aspiration pneumonitis and aspiration pneumonia. Clinical features assist in differentiating these two entities. Unlike aspiration pneumonitis, the aspiration event is not frequently witnessed in aspiration pneumonia [ 5 , 75 ]. If aspiration as a preceding event is not obvious, the patient is more likely to have aspiration pneumonia.
A large volume of stomach contents is needed to induce chemical pneumonitis, resulting in a more evident aspiration events in cases of aspiration pneumonitis. Furthermore, the clinical course of aspiration pneumonitis is more rapidly progressing; hyper-acute hypoxemia occurs, and devastating lung injury can occur and be resolved within 48 hours. These patients are likely to exhibit symptoms such as bronchospasm, frothy sputum, and bilateral patchy infiltrates, even in nondependent lung fields [ 5 , 75 ].
Features that differ between aspiration pneumonitis and aspiration pneumonia are outlined in Table 3. However, there is no gold standard to differentiate between these two entities. Due to these difficulties, there have been attempts to use biomarkers.
El-Solh et al. Indeed, the serum concentration of procalcitonin increases under various bacterial and viral infections [ 77 ]. However, no significant differences in procalcitonin levels were observed between the negative-culture-group and the positive-culture-group of bronchoalveolar lavage fluid.
The main principle of treatment is that immediate cares based on the symptomatology and progression of the disease is essential prior to any efforts to differentiate between aspiration pneumonitis and pneumonia. However, the direction of the treatment is different for the two conditions and consists of supportive management itself for aspiration pneumonitis and antimicrobial therapy for aspiration pneumonia [ 74 ].
If aspiration is witnessed or suspected, the patient's position should be adjusted to minimize the risk of additional aspiration.
For conscious patients, the head should be rotated laterally, and suction is applied to the oral and pharyngeal cavities [ 78 ]. Humidified oxygen should be administered and nebulized bronchodilator is used if necessary. Furthermore, the head of bed is raised by 45 degrees. Indications for intubation are similar to the general indications based on the general neurologic status, degree of hypoxia, and hemodynamic stability.
To facilitate bronchoscopy in large volume solid aspiration, intubation is preferred [ 78 , 79 ]. Mechanical ventilation should be provided using the lung protective strategy. To prevent recurrent aspiration, a nasogastric tube is inserted and gastric decompression is performed through either suction or gravity drainage.
Quantitative bacteriology using a bronchoalveolar lavage sample obtained through bronchoscopy not only serves as a guide for definitive therapy and de-escalation of antibiotics but can also aid decisions on whether antibiotics should be discontinued if there is no significant bacterial growth [ 80 ]. In aspiration pneumonitis, antibiotic therapy is not necessary. However, since it is difficult to distinguish between pneumonitis and pneumonia, it is common practice to use antibiotics with the potential for aspiration pneumonia in mind.
In a survey, the majority of intensivists prescribed antibiotics to patients suspected of aspiration, and The choice of antibiotics can vary based on the local ecology of the ICU. However, it is considered adequate to start with early, empiric, and broad-spectrum antibiotics [ 82 ]. Subsequently, during the next 72 hours, the use of antibiotics is de-escalated based on definitive and quantitative culture.
In case no significant bacterial growth is observed in the culture, the antibiotics are then discontinued. Based on the bacteriological trend, the use of antibiotics for anaerobic coverage is unnecessary.
However, in cases of severe periodontal diseases or evidence of necrotizing pneumonia or lung abscess in computed tomography, the use of antibiotics with anaerobic coverage can be considered [ 60 , 83 ]. Despite proper treatment, aspiration pneumonitis and aspiration pneumonia exhibit high morbidity and mortality; therefore, prevention is crucial. The primary purposes of prevention, for patients with risk factors of aspiration, are to reduce the frequency and amount of aspiration and to minimize the colonization of pathogenic organisms.
General anesthesia is a key risk factor of gastric aspiration, and an opportunity for proactive management and prevention. Fasting prior to the surgery or procedure is one of the key preventive measures to avoid gastric aspiration during general anesthesia. However, for clear liquids, fasting for longer than 2 h has not shown additional benefits in lowering the risk [ 84 , 85 ].
Based on these facts, ASA recommends 2-h fasting for clear liquids for patients of all age groups. The role of fasting when performing sedation for procedures in the emergency department ED is controversial. This is because the risk of aspiration during sedation for procedures in ED is thought to be very low, and ED patients are typically healthy without preparation for fasting prior to the admission [ 86 ]. Nevertheless, when performing sedation for the procedure, preventive measures, such as adjusting the sedation depth, identifying high risk patients, and monitoring during the procedure, must be considered.
The most important intervention to prevent aspiration in inpatients and ICU patients is to position the patients in a semi-recumbent position. Using radioactively labeled gastric contents, it has been found that positioning patients under mechanical ventilation into a semi-recumbent position results in a reduced rate of reflux, thus mitigating the risk of aspiration [ 87 , 88 ]. Indeed, the frequency of aspiration was higher in patients in supine position, while the frequency was dependent on the duration of the supine position.
In a clinical study comparing the occurrence rate of nosocomial pneumonia in patients under mechanical ventilation, it has been observed that the patient group in semi-recumbent position had significantly lower occurrence rate compared with the patient group in supine position.
Furthermore, the difference was more definite in patients receiving enteral feeding [ 89 ]. Currently, the semi-recumbent position is a standard practice to prevent aspiration and associated complications.
Dietary intervention has been attempted in patients with dysphasia. The occurrence rate of aspiration pneumonia has been reported to be lower in pseudobulbar dysphagia patients that received mechanical diet with thickened liquids compared with the patients that received pureed diet with thin liquids [ 90 ].
However, the occurrence rate of pneumonia was comparable among post-stroke patient groups who were divided into three randomized groups depending on the degree of dietary intervention by a dysphagia therapist [ 91 ]. Given that enteric tube feeding increases the risk of aspiration, several attempts have been made to compare different forms of tube feeding to minimize the risk. The most relevant comparison was between gastric and post-pyloric feeding.
When considering gastric dysmotility due to a critical illness, gastroparesis, or medication, the post-pyloric feed was thought to be a superior option [ 92 ]. However, two randomized prospective clinical studies have reported no difference in the aspiration rates between the two feeding types [ 93 , 94 ]. In terms of efficiency to reach the nutritional goal, post-pyloric feed has been considered superior to gastric feeding [ 95 , 96 ].
Previous randomized clinical trials have reported no difference in pneumonia complication rate between the nasogastric tube feed and the percutaneous endoscopic gastrostomy tube feed [ 97 , 98 ]. Poor oral hygiene increases the risk of aspiration pneumonia. Therefore, oral health care can help prevent aspiration pneumonia by reducing the risk. Currently, the concept of oral health care includes not only oral cleaning but also eating function training. Through oral hygiene management, including oral moisture retention and mechanical cleaning of the tongue and palate, the bacterial burden can be minimized.
And improving eating function reduces the occurrence rate of large-volume aspiration [ 70 ]. Aspiration pneumonitis and pneumonia are acute pulmonary diseases that occur following macroaspiration. Distinguishable characteristics from other aspiration syndromes include rapid progression after large volume aspiration. Although these two diseases are difficult to distinguish clinically, they are two independent disease entities with characteristic pathophysiology. Aspiration pneumonitis is a lung injury from acute inflammation that occurs after chemical burns in the airways and lung parenchyma, while aspiration pneumonia is a pulmonary infection from large-volume aspiration of an infection source.
When respiratory or systemic symptoms are observed, supportive care for different symptoms must be immediately provided. Treatment with early, empiric, broad-spectrum antibiotics should be administered then selection of pathogen specific antibiotics or decision to stop or continue the use of antibiotics is made based on quantitative bacteriology. National Center for Biotechnology Information , U. J Dent Anesth Pain Med. Published online Mar Find articles by Young Gon Son. Find articles by Jungho Shin.
Find articles by Ho Geol Ryu. Author information Article notes Copyright and License information Disclaimer. Corresponding author. This article has been cited by other articles in PMC. Abstract Aspiration pneumonitis and aspiration pneumonia are clinical syndromes caused by aspiration. Keywords: Pneumonia, Aspiration; Pneumonitis. Table 1 Aspiration syndromes. Open in a separate window.
RISK FACTORS Aspiration is frequently observed in patients with conditions including altered mental status, dysphagia or swallowing dysfunction, esophageal motility disorders, gastrointestinal disorders, and enteral tube feeding.
Table 2 Risk factors for frequent or large volume aspiration. DIAGNOSIS Patients with risk factors for aspiration can be suspected of having aspiration in case they show acute symptoms such as coughing, choking, shortness of breath, cyanosis, tachypnea, tachycardia, speaking difficulty, and hoarseness [ 2 ].
Table 3 Comparison between aspiration pneumonitis and aspiration pneumonia. Aspiration pneumonitis Aspiration pneumonia Primary mechanism Aspiration of sterile gastric contents Aspiration of colonized oropharyngeal material Pathophysiology Acute lung injury from acidic and particulate gastric material Acute pulmonary inflammatory response to bacteria and bacterial products Bacteriologic finding Initially sterile, with subsequent bacterial infection possible Gram-positive, gram-negative rods, and rarely anaerobes Main risk factors Depressed level of consciousness Dysphagia and gastric dysmotility Aspiration event May be witnessed Usually not witnessed Typical presentation Patient with depressed level of consciousness in whom a pulmonary infiltrate and respiratory symptoms develop Institutionalized patient with dysphasia in whom clinical feature of pneumonia and an infiltrate in a dependent bronchopulmonary segment develop.
TREATMENT The main principle of treatment is that immediate cares based on the symptomatology and progression of the disease is essential prior to any efforts to differentiate between aspiration pneumonitis and pneumonia. References 1. Venes D. In: Taber's cyclopedic medical dictionary. Davis FA, editor. Zaloga GP. Aspiration-related illnesses: Definitions and diagnosis. Pharyngeal aspiration in normal adults and patients with depressed consciousness.
Am J Med. Aspiration pneumonia: A review of modern trends. J Crit Care. Marik PE. Aspiration pneumonitis and aspiration pneumonia. N Engl J Med. Teabeaut JR.
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