Everything "Aspiration Pneumonia" for the incoming IM interns 🤮🫁:
3 major types of aspiration sequelae!
🫁 Mechanical obstruction (straightforward)
🫁 Chemical pneumonitis ("aspiration pneumonitis")
🫁 Bacterial aspiration pneumonia (*true* pneumonia)
1/x
3 major types of aspiration sequelae!
🫁 Mechanical obstruction (straightforward)
🫁 Chemical pneumonitis ("aspiration pneumonitis")
🫁 Bacterial aspiration pneumonia (*true* pneumonia)
1/x
Differentiating chemical pneumonitis from bacterial aspiration pneumonia is 🔑 since antibiotics not always necessary in the former.
Let's compare both.
2/x
Let's compare both.
2/x
Chemical pneumonitis:
💊 What? Gastric fluid causes lower airway inflammation
💊 Who? Large-volume aspiration often 2/2 general anesthesia or narcotics
💊 Abrupt-onset respiratory symptoms, fever (usually low-grade), diffuse crackles/wheeze
3/x
💊 What? Gastric fluid causes lower airway inflammation
💊 Who? Large-volume aspiration often 2/2 general anesthesia or narcotics
💊 Abrupt-onset respiratory symptoms, fever (usually low-grade), diffuse crackles/wheeze
3/x
CXR shows:
💊 Gravity-dependent opacities (eg basilar if upright patient)
💊 Large-volume aspiration may progress to ARDS-like changes
Antibiotics *only* if:
💊 Progressive/persistent respiratory symptoms & inflammation.
💊 Discontinue if above rapidly improving
4/x
💊 Gravity-dependent opacities (eg basilar if upright patient)
💊 Large-volume aspiration may progress to ARDS-like changes
Antibiotics *only* if:
💊 Progressive/persistent respiratory symptoms & inflammation.
💊 Discontinue if above rapidly improving
4/x
Bacterial aspiration pneumonia:
🦠 What? Aspiration of large bacterial load leading to true pneumonia
🦠 Who? Periodontal disease, Dysphagia, Impaired Consciousness
🦠 Insidious-onset pneumonia symptoms, (-) rigors (but B-symptoms if abscess), putrid productive cough
5/x
🦠 What? Aspiration of large bacterial load leading to true pneumonia
🦠 Who? Periodontal disease, Dysphagia, Impaired Consciousness
🦠 Insidious-onset pneumonia symptoms, (-) rigors (but B-symptoms if abscess), putrid productive cough
5/x
Studies show:
🧫 Sputum - PMNs & "normal oral flora" (ie "culture negative")
🧫 WBC count - normal (or near-normal)
6/x
🧫 Sputum - PMNs & "normal oral flora" (ie "culture negative")
🧫 WBC count - normal (or near-normal)
6/x
CXR shows:
🦠 Patchy, basilar, nodular, & round opacities (often +effusion)
🦠 Necrotizing PNA & Pseudo-necrosis (spillage into pre-existing cavity)
🦠 Abscess & Empyema (+hydropneumothorax if empyema)
Ref: @LandsbergManual
7/x
🦠 Patchy, basilar, nodular, & round opacities (often +effusion)
🦠 Necrotizing PNA & Pseudo-necrosis (spillage into pre-existing cavity)
🦠 Abscess & Empyema (+hydropneumothorax if empyema)
Ref: @LandsbergManual
7/x
Treatment?
💊 Varies by setting & severity: see below for UpToDate's recommendations
8/x
💊 Varies by setting & severity: see below for UpToDate's recommendations
8/x
Summary:
💊 Chemical pneumonitis = ACUTE. In large-volume aspiration can resemble ARDS. No abx if no progressive/persistent sxs/signs.
🦠 Bacterial aspiration pneumonia = INSIDIOUS. Can progress into abscess, empyema, hydropneumo., necr. pneumonia.
9/x
💊 Chemical pneumonitis = ACUTE. In large-volume aspiration can resemble ARDS. No abx if no progressive/persistent sxs/signs.
🦠 Bacterial aspiration pneumonia = INSIDIOUS. Can progress into abscess, empyema, hydropneumo., necr. pneumonia.
9/x
Other tips/corrections appreciated!
Ref:
- @LandsbergManual
- UpToDate: #H12" target="_blank" rel="noopener" onclick="event.stopPropagation()">uptodate.com
Ref:
- @LandsbergManual
- UpToDate: #H12" target="_blank" rel="noopener" onclick="event.stopPropagation()">uptodate.com
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