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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