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Aspiration Pneumonitis and Pneumonia
- Aspiration of low pH gastric fluid or food matter is common in critically ill patients and often underdiagnosed.
- Patients with aspiration initially develop a pneumonitis that, in some, can be complicated by bacterial pneumonia. Up to 33% develop severe ALI/ARDS, with an associated 30% mortality rate.
- Aspiration pneumonitis presents with hypoxia and a CXR demonstrating infiltrates in the dependent portion of the lungs. Often, the degree of respiratory distress is worse than the CXR appearance.
- Since it is challenging to differentiate aspiration pneumonia from aspiration pneumonitis, current recommendations suggest initiating empiric antibiotics with agents that have adequate Gram-negative coverage. Routine coverage against anaerobic bacteria is not currently recommended, except in patients with severe periodontal disease and those with a lung abscess on CXR or CT.
- Despite the initial inflammatory response, steroids are not indicated for patients with aspiration.
References
Ragavendran K, Nemzek J, Napolitano LM, Knight PR. Aspiration-induced lung injury. Crit Care Med 2011; 39:818-26.