eMedicine Specialties > Pulmonology > Aspiration and Atelectasis

Pneumonia, Aspiration: Follow-up

Author: Anita B Varkey, MD, Assistant Professor, Department of Medicine, Loyola University Medical Center; Associate Program Director, Internal Medicine Residency; Medical Director, General Internal Medicine Clinic, Loyola Outpatient Center
Coauthor(s): Basil Varkey, MD, FCCP, Professor, Department of Internal Medicine, Division of Pulmonary and Critical Care, Medical College of Wisconsin; Consulting Pulmonologist, Froedtert Memorial Lutheran Hospital
Contributor Information and Disclosures

Updated: Aug 7, 2009

Follow-up

Further Inpatient Care

  • Patients with aspiration pneumonia, both chemical pneumonia (CP) and bacterial pneumonia (BP), need inpatient care for several reasons, including the acuity of illness, host factors, and the uncertain course and prognosis of aspiration pneumonia.

Further Outpatient Care

  • Patients who recover from CP generally do not require additional outpatient care, except for adherence to measures to prevent further aspiration episodes.
  • Because anaerobic bacterial infections require prolonged antibiotic treatment, outpatient treatment is necessary. Patients can be discharged from the hospital after clinical improvement and stability (eg, no fever, no leucocytosis, resolution of hypoxemia) and radiographic improvement (eg, decreased infiltrate or cavity size, no pleural effusion).

Inpatient & Outpatient Medications

  • Oral antibiotic therapy (ie, clindamycin) is continued for several weeks. In treating a lung abscess, 6-8 weeks of daily antibiotic therapy may be required until the cavity has disappeared or diminished in size and has remained stable for more than 1 week.

Deterrence/Prevention

  • Position patients with altered consciousness in a semirecumbent position with the head of the bed at a 30- to 45-degree angle. Use nonparticulate antacids and histamine 2 (H2) blockers to reduce gastric acidity. Use antiemetics to reduce lower esophageal sphincter pressure. Before starting enteral tube feeding, confirm the tip location radiographically. Check residual gastric volume regularly. For those on bolus tube, feeding residual should not exceed 150 mL before the next bolus feed.
  • For patients with known swallowing dysfunction, helpful compensatory techniques to reduce aspiration include a soft diet reducing the bite size, keeping the chin tucked and the head turned, and repeated swallowing.

Complications

  • Complications of CP
    • ARDS
    • Nosocomial BP
  • Complications of BP
    • Para-pneumonic effusion
    • Empyema
    • Lung abscess
  • Bronchopleural fistula

Prognosis

  • The prognosis of both CP and BP is dependent on underlying diseases, complications, and host status.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Not recognizing or not weighing the risk for aspiration based on predisposing conditions
  • Feeding patients at high risk for aspiration
  • Resumption of feeding after intubation without assessing patient's ability to swallow and gastric motility
  • Delay in diagnosis of anaerobic lung abscess because of subacute presentation
  • Misdiagnosis of anaerobic lung abscess (mistaken for lung carcinoma or tuberculosis)
 


More on Pneumonia, Aspiration

Overview: Pneumonia, Aspiration
Differential Diagnoses & Workup: Pneumonia, Aspiration
Treatment & Medication: Pneumonia, Aspiration
Follow-up: Pneumonia, Aspiration
Multimedia: Pneumonia, Aspiration
References
Further Reading
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References

  1. Mendelson CL. The aspiration of stomach contents into the lungs during obstetric anesthesia. Am J Obstet Gynecol. 1946;52:191.

  2. [Guideline] Coffin SE, Klompas M, Classen D, Arias KM, Podgorny K, Anderson DJ, et al. Strategies to prevent ventilator-associated pneumonia in acute care hospitals. Infect Control Hosp Epidemiol. Oct 2008;29 Suppl 1:S31-40. [Medline].

  3. [Guideline] Tablan OC, Anderson LJ, Besser R, Bridges C, Hajjeh R. Guidelines for preventing health-care--associated pneumonia, 2003: recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee. MMWR Recomm Rep. Mar 26 2004;53:1-36. [Medline].

  4. American Thoracic Society. Hospital-acquired pneumonia in adults: diagnosis, assessment of severity, initial antimicrobial therapy, and preventive strategies. A consensus statement, American Thoracic Society, November 1995. Am J Respir Crit Care Med. May 1996;153(5):1711-25. [Medline].

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  15. Matthay MA, Rosen GD. Acid aspiration induced lung injury. New insights and therapeutic options. Am J Respir Crit Care Med. Aug 1996;154(2 Pt 1):277-8. [Medline].

  16. Sullivan RJ Jr, Dowdle WR, Marine WM. Adult pneumonia in a general hospital. Etiology and host risk factors. Arch Intern Med. Jun 1972;129(6):935-42. [Medline].

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  19. Varkey B, Kutty K. Pulmonary aspiration syndromes. In: Kochar's Concise Textbook of Medicine. Baltimore, Md:. Lippincott Williams & Wilkins;1998:902-906.

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Further Reading

Clinical guidelines

Coffin SE, Klompas M, Classen D, Arias KM, Podgorny K, Anderson DJ, Burstin H, Calfee DP, Dubberke ER, Fraser V, Gerding DN, Griffin FA, Gross P, Kaye KS, Lo E, Marschall J, Mermel LA, Nicolle L, Pegues DA, Perl TM, Saint S, Salgado CD, Weinstein RA, Wise R, Yokoe DS. Strategies to prevent ventilator-associated pneumonia in acute care hospitals. Infect Control Hosp Epidemiol 2008 Oct;29 Suppl 1:S31-40. 2

Tablan OC, Anderson LJ, Besser R, Bridges C, Hajjeh R. Guidelines for preventing health-care--associated pneumonia, 2003: recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee. MMWR Recomm Rep 2004 Mar 26;53(RR-3):1-36. 3

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Keywords

aspiration pneumonia, Mendelson syndrome, chemical pneumonitis, anaerobic bacterial pneumonia, chemical pneumonia, CP, aspiration of gastric acid, bacterial pneumonia, BP, aspiration of bacteria from oral and pharyngeal areas, exogenous lipoid pneumonia, aspiration of oil, aspiration of a foreign body, acute respiratory emergency, parenchymal inflammatory reaction, community-acquired pneumonia, CAP, nosocomial pneumonia, acute respiratory distress syndrome, ARDS

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Contributor Information and Disclosures

Author

Anita B Varkey, MD, Assistant Professor, Department of Medicine, Loyola University Medical Center; Associate Program Director, Internal Medicine Residency; Medical Director, General Internal Medicine Clinic, Loyola Outpatient Center
Anita B Varkey, MD is a member of the following medical societies: American College of Physicians and Society of General Internal Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Basil Varkey, MD, FCCP, Professor, Department of Internal Medicine, Division of Pulmonary and Critical Care, Medical College of Wisconsin; Consulting Pulmonologist, Froedtert Memorial Lutheran Hospital
Basil Varkey, MD, FCCP is a member of the following medical societies: American Association of Physicians of Indian Origin, American College of Chest Physicians, American Federation for Clinical Research, American Thoracic Society, and Royal College of Physicians
Disclosure: Nothing to disclose.

Medical Editor

Laurie Robin Grier, MD, Medical Director of MICU, Associate Professor of Medicine, Section of Pulmonary and Critical Care Medicine, Louisiana State University Health Science Center at Shreveport
Laurie Robin Grier, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, American Society for Parenteral and Enteral Nutrition, and Society of Critical Care Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

,, Kathy Roarty Placeholder
Disclosure: Nothing to disclose.

CME Editor

Timothy D Rice, MD, Associate Professor, Departments of Internal Medicine and Pediatrics and Adolescent Medicine, Saint Louis University School of Medicine
Timothy D Rice, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Physicians
Disclosure: Nothing to disclose.

Chief Editor

Zab Mosenifar, MD, Director, Division of Pulmonary and Critical Care Medicine, Director, Women's Guild Pulmonary Disease Institute, Executive Vice Chair, Department of Medicine, Cedars Sinai Medical Center; Professor of Medicine, David Geffen School of Medicine at UCLA
Zab Mosenifar, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, American Federation for Medical Research, and American Thoracic Society
Disclosure: Nothing to disclose.

 
 
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