Aspiration pneumonia and pneumonitis: Difference between revisions
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**Lower lobe infiltrate when aspiration occurs in upright position | |||
**Upper lobe infiltrate when aspiration occurs in recumbent position | |||
==Treatment== | ==Treatment== | ||
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Tintinalli | *Tintinalli | ||
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Revision as of 22:34, 27 February 2012
Background
- Difficult to predict which pts with pneumonitis will go on to develop PNA
- Aspiration pneumonitis
- Inflammatory chemical injury of tracheobronchial tree and pulmonary parenchyma
- Due to inhalation of regurgitated sterile gastric contents
- Must aspirate at least 20-30mL of gastric contents with pH <2.5
- Can lead to aspiration PNA d/t pulmonary defense mechanism injury
- Due to inhalation of regurgitated sterile gastric contents
- Inflammatory chemical injury of tracheobronchial tree and pulmonary parenchyma
- Aspiration pneumonia
- Alveolar space infection d/t inhalation of pathogenic material from oropharynx
- Increased in pts w/ periodontal dz, chronic colonization of upper airways, PPI/H2 meds
- Accounts for up to 20% of CAP in elderly, majority of nursing home-acquired PNA
- Microbiology
- Community acquired: Pneumococcus, staph, H flu, enterobacter
- Hospital acquired: Pseudomonas, gram-negatives
- Alveolar space infection d/t inhalation of pathogenic material from oropharynx
Diagnosis
- Aspiration pneumonitis
- Cough, tachypnea, bloody sputum, respiratory distress
- Aspiration PNA
- Fever, dyspnea, productive cough, Tachypnea, tachycardia, AMS
- CXR
- Unilateral focal or patchy consolidations in dependent lung segments
- Right lower lobe is most common area; bilateral patterns can also be seen
- Unilateral focal or patchy consolidations in dependent lung segments
Work-Up
- CXR
- Lower lobe infiltrate when aspiration occurs in upright position
- Upper lobe infiltrate when aspiration occurs in recumbent position
Treatment
- Aspiration pneumonitis
- Suction upper airway if aspiration is witnessed
- Abx
- Only recommended if symptoms persist >48hr
- Levo/moxifloxacin or clindamycin or amoxicillin-clavulanate
- Only recommended if symptoms persist >48hr
- Aspiration pneumonia
- Community-acquired
- Moxifloxacin or clinda or amoxicillin-clavulanate
- Health care-associated or periodontal disease or alcoholism
- CTX + clindamycin OR
- Piperacillin-tazobactam + clindamycin OR
- Ampicillin-sulbactam + clindamycin OR
- Cefepime + clindamycin OR
- Levofloxacin + clindamycin
- Community-acquired
Disposition
- Healthy person
- Observe for 1hr; if asymptomatic discharge
- If mild-moderate symptoms develop and persist >48hr treat with antibiotics
- Chronically ill or nursing home pt
- Consider ED obs unit versus short admission for observation +/- prophylactic abx
- Admit all pts w/ aspiration PNA
See Also
Source
- Tintinalli
- UpToDate