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

Parkinson’s

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

ᴥ Fever

ᴥ Sputum purulence

ᴥ Abscess/complication

Solid Particle Aspiration

Large particles

Sudden respiratory distress, cyanosis,

aphonia

Heimlich!

Small particles

Irritative cough, unilateral wheezing

Remember: bacterial superinfection is common

T h a n k Y o u