Aspiration pneumonia and pneumonitis - Revision history

Rossdonaldson1: /* Background */

2024-04-24T21:29:45Z

Background

← Older revision		Revision as of 21:29, 24 April 2024
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	==Background==		==Background==
			[[File:Lung and diaphragm.jpg\|thumb\|Lobes of the lung with related anatomy.]]
	*Difficult to predict which patients with pneumonitis will go on to develop pneumonia, aspiration alone does not cause pneumonia		*Difficult to predict which patients with pneumonitis will go on to develop pneumonia, aspiration alone does not cause pneumonia
	*Witnessed aspiration key to distinguishing between the two		*Witnessed aspiration key to distinguishing between the two

Rossdonaldson1: /* Evaluation */

2024-04-10T17:57:29Z

Evaluation

← Older revision		Revision as of 17:57, 10 April 2024
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	==Evaluation==		==Evaluation==
			[[File:AspirationPneumonia.png\|thumb\|Aspiration pneumonia in a ventilated person with a central line and nasogastric tube.]]
	[[File:PMC2714572 ATM-04-149-g020.png\|thumb\|Chest X-ray of the patient showing (left) multifocal patchy consolidation consistent with aspiration pneumonitis and (right) the decreased extent of pulmonary opacification in both central lung areas 3 days after initiation of the treatment.]]		[[File:PMC2714572 ATM-04-149-g020.png\|thumb\|Chest X-ray of the patient showing (left) multifocal patchy consolidation consistent with aspiration pneumonitis and (right) the decreased extent of pulmonary opacification in both central lung areas 3 days after initiation of the treatment.]]
	===Work-Up===		===Work-Up===

Rossdonaldson1: /* Evaluation */

2023-01-11T21:13:03Z

Evaluation

← Older revision		Revision as of 21:13, 11 January 2023
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	==Evaluation==		==Evaluation==
	[[File:PMC2714572 ATM-04-149-g020.png\|thumb\|Chest X-ray of the patient showing multifocal patchy consolidation consistent with aspiration pneumonitis (A) ~~and~~ the decreased extent of pulmonary opacification in both central lung areas 3 days after initiation of the treatment ~~(B)~~.]]		[[File:PMC2714572 ATM-04-149-g020.png\|thumb\|Chest X-ray of the patient showing (left) multifocal patchy consolidation consistent with aspiration pneumonitis and (right) the decreased extent of pulmonary opacification in both central lung areas 3 days after initiation of the treatment.]]
	===Work-Up===		===Work-Up===
	*[[CXR]]		*[[CXR]]

Rossdonaldson1: /* Evaluation */

2023-01-11T21:11:35Z

Evaluation

← Older revision		Revision as of 21:11, 11 January 2023
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	==Evaluation==		==Evaluation==
			[[File:PMC2714572 ATM-04-149-g020.png\|thumb\|Chest X-ray of the patient showing multifocal patchy consolidation consistent with aspiration pneumonitis (A) and the decreased extent of pulmonary opacification in both central lung areas 3 days after initiation of the treatment (B).]]
	===Work-Up===		===Work-Up===
	*[[CXR]]		*[[CXR]]

Rossdonaldson1: /* Risk factors */

2023-01-11T21:05:42Z

Risk factors

← Older revision		Revision as of 21:05, 11 January 2023
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	***Hospital acquired: [[Pseudomonas]], [[gram-negative]]s		***Hospital acquired: [[Pseudomonas]], [[gram-negative]]s

	==Risk factors==		===Risk factors===
	*Advanced age		*Advanced age
	*Altered level of consciousness		*Altered level of consciousness

Rossdonaldson1: /* Clinical Features */

2023-01-11T21:05:28Z

Clinical Features

← Older revision		Revision as of 21:05, 11 January 2023
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	**Productive [[cough]]		**Productive [[cough]]
	**[[Tachypnea]]		**[[Tachypnea]]
	**[[Tachycardia		**[[Tachycardia]]
	**[[Altered mental status]]		**[[Altered mental status]]
	*Aspiration pneumonitis		*Aspiration pneumonitis

Rossdonaldson1: /* Work-Up */

2023-01-11T21:05:10Z

Work-Up

← Older revision		Revision as of 21:05, 11 January 2023
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	**Lower lobe infiltrate when aspiration occurs in upright position		**Lower lobe infiltrate when aspiration occurs in upright position
	**Upper lobe infiltrate when aspiration occurs in recumbent position		**Upper lobe infiltrate when aspiration occurs in recumbent position
	*[[CT]]		*CT
	**Increased sensitivity, specificity, and overall accuracy compared to CXR		**Increased sensitivity, specificity, and overall accuracy compared to CXR
	**Reasonable to obtain even if CXR negative if clinical suspicion is high		**Reasonable to obtain even if CXR negative if clinical suspicion is high

Rossdonaldson1: /* Management */

2023-01-11T21:03:42Z

Management

← Older revision		Revision as of 21:03, 11 January 2023
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	==Management==		==Management==
	*Aspiration pneumonitis		===Aspiration pneumonitis===
	**Suction upper airway if aspiration is witnessed		*Suction upper airway if aspiration is witnessed
	**Caused by aspiration of gastric contents. Usually resolves in 24-48 hrs w/o treatment		*Caused by aspiration of gastric contents. Usually resolves in 24-48 hrs w/o treatment
	**Antibiotics '''only''' recommended if symptoms persist >48hr		*Antibiotics '''only''' recommended if symptoms persist >48hr
	***Same as those for community-acquired aspiration pneumonia below		**Same as those for community-acquired aspiration pneumonia below
	*Aspiration pneumonia
	**Treat same as [[community acquired pneumonia]] (see below)		===Aspiration pneumonia===
	***Routinely adding anaerobic coverage beyond the standard empiric treatment for community-acquired aspiration pneumonia is no longer recommended unless lung abscess, [[empyema]], healthcare-associated, periodontal disease, or [[SBO]]<ref>Metlay JP, Waterer GW, Long AC, et al. Diagnosis and treatment of adults with community-acquired pneumonia. An official clinical practice guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med. 2019;200(7):e45–e67.</ref>		*Treat same as [[community acquired pneumonia]] (see below)
			**Routinely adding anaerobic coverage beyond the standard empiric treatment for community-acquired aspiration pneumonia is no longer recommended unless lung abscess, [[empyema]], healthcare-associated, periodontal disease, or [[SBO]]<ref>Metlay JP, Waterer GW, Long AC, et al. Diagnosis and treatment of adults with community-acquired pneumonia. An official clinical practice guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med. 2019;200(7):e45–e67.</ref>

	{{Pneumonia Antibiotics}}		{{Pneumonia Antibiotics}}

Rossdonaldson1: /* Management */

2023-01-11T21:00:27Z

Management

← Older revision		Revision as of 21:00, 11 January 2023
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	***Same as those for community-acquired aspiration pneumonia below		***Same as those for community-acquired aspiration pneumonia below
	*Aspiration pneumonia		*Aspiration pneumonia
	**Treat same as [[~~CAP~~]]		**Treat same as [[community acquired pneumonia]] (see below)
	**Antibiotics:		***Routinely adding anaerobic coverage beyond the standard empiric treatment for community-acquired aspiration pneumonia is no longer recommended unless lung abscess, [[empyema]], healthcare-associated, periodontal disease, or [[SBO]]<ref>Metlay JP, Waterer GW, Long AC, et al. Diagnosis and treatment of adults with community-acquired pneumonia. An official clinical practice guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med. 2019;200(7):e45–e67.</ref>
	***Monotherapy: [[Levofloxacin]] 750 mg daily '''OR''' [[moxifloxacin]] 400 mg daily
	***or combination therapy: [[Ampicillin-sulbactam]] 3 g q6h '''OR''' [[ceftriaxone]] 2 g daily '''PLUS''' [[azithromycin]] 500 mg daily '''OR''' [[clarithromycin]] 500 mg BID.		{{Pneumonia Antibiotics}}
	***Routinely adding anaerobic coverage beyond the standard empiric treatment for community-acquired aspiration pneumonia is no longer recommended unless lung abscess, empyema, healthcare-associated, periodontal disease, or SBO:<ref>Metlay JP, Waterer GW, Long AC, et al. Diagnosis and treatment of adults with community-acquired pneumonia. An official clinical practice guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med. 2019;200(7):e45–e67.</ref> ~~[[Metronidazole]] 500 mg q8h '''OR''' [[clindamycin]] 600 mg q8h~~

	==Disposition==		==Disposition==

Rossdonaldson1: /* Management */

2023-01-11T20:45:57Z

Management

← Older revision		Revision as of 20:45, 11 January 2023
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	***Same as those for community-acquired aspiration pneumonia below		***Same as those for community-acquired aspiration pneumonia below
	*Aspiration pneumonia		*Aspiration pneumonia
	**Treat same as CAP		**Treat same as [[CAP]]
	**Antibiotics:		**Antibiotics:
	***Monotherapy: [[Levofloxacin]] 750 mg daily '''OR''' [[moxifloxacin]] 400 mg daily		***Monotherapy: [[Levofloxacin]] 750 mg daily '''OR''' [[moxifloxacin]] 400 mg daily