Aspiration Pneumonia

Posted by e-Medical PPT
Misdirection of gastric contents into the larynx resulting from alteration in lower airway defenses such as glottic closure and the cough reflexHalf of all adults aspirate small amounts of oropharyngeal contents in their sleep
Aspiration pneumonia may occur in up to 10% of nursing home residents annually

Predisposing Factors
Decreased consciousness
Alcohol
Drugs
Hepatic failure
CVA
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
Parkinson’s
Myasthenia gravis

Chemical Pneumonitis
Pathophysiology
Animal models demonstrate that clinically significant pneumonitis results from aspirating at least 1ml/kg of pH<2.5 gastric contents
Fluids that are not harmful to the airway
Water, saline, barium, gastric contents with pH>2.5

Clinical feature
Abrupt onset of dyspnea
Low grade fever
Pink frothy sputum
Diffuse crackles on exam
CXR: diffuse infiltrates

Bacterial Pneumonitis
Clinical features
Much more insidious onset than chemical pneumonitis (days to weeks)
Cough
Fever
Purulent sputum
CXR: Infiltrate frequently in dependent segments

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