eMedicine Specialties > Emergency Medicine > Pulmonary

Pneumonia, Aspiration: Follow-up

Author: Anand Swaminathan, MD, Chief Resident Physician, Department of Emergency Medicine, New York University/Bellevue Hospital Center
Coauthor(s): Sassan Naderi, MD, Staff Physician, Department of Emergency Medicine, North Shore/Long Island Jewish Health System, Albert Einstein College of Medicine
Contributor Information and Disclosures

Updated: May 5, 2009

Follow-up

Further Inpatient Care

  • Admit patients with severe hemodynamic compromise and/or persistent respiratory distress to the ICU.
  • Admit the patient to a general-care floor if the patient's respiratory status is stabilized.

Transfer

  • Intubated and ventilated patients must be transferred to a hospital with an ICU.
  • Patients with signs or symptoms indicating severe sepsis or septic shock should be transferred to a hospital with an ICU.

Deterrence/Prevention

  • Keep the head of the bed at a 30° angle. The semirecumbent body position reduces the risk or aspiration leading to pneumonia.
  • Patients with dysphagia and/or a poor gag reflex should not be fed orally; feeding through a nasogastric or gastric tube may be required.

Complications

  • Acute respiratory failure
  • Acute respiratory distress syndrome
  • Empyema
  • Pulmonary abscess
  • Superinfection

Prognosis

  • The mortality associated with aspiration pneumonia mimics that of community-acquired pneumonia: approximately 1% in the outpatient setting and up to 25% in those requiring hospitalization.
  • The mortality rate of massive aspiration pneumonitis (Mendelson syndrome) approaches 70%.
  • The mortality rate for aspiration pneumonitis complicated by empyema is approximately 20%.
  • The mortality for uncomplicated pneumonitis is approximately 5%.

Patient Education

 


More on Pneumonia, Aspiration

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

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  2. Marik PE. Aspiration pneumonitis and aspiration pneumonia. N Engl J Med. Mar 1 2001;344(9):665-71. [Medline].

  3. Akritidis N, Gousis C, Dimos G, Paparounas K. Fever, cough, and bilateral lung infiltrates. Achalasia associated with aspiration pneumonia. Chest. Feb 2003;123(2):608-12. [Medline].

  4. Marom EM, McAdams HP, Erasmus JJ. The many faces of pulmonary aspiration. AJR Am J Roentgenol. Jan 1999;172(1):121-8. [Medline].

  5. Drakulovic MB, Torres A, Bauer TT, et al. Supine body position as a risk factor for nosocomial pneumonia in mechanically ventilated patients: a randomised trial. Lancet. Nov 27 1999;354(9193):1851-8. [Medline].

  6. Lumpkin JR, Westfall MD. Aspiration pneumonia. In: Emergency Medicine: Concepts and Clinical Practice. 1992:1112-20.

  7. Marik PE, Careau P. The role of anaerobes in patients with ventilator-associated pneumonia and aspiration pneumonia: a prospective study. Chest. Jan 1999;115(1):178-83. [Medline].

  8. Mier L, Dreyfuss D, Darchy B. Is penicillin G an adequate initial treatment for aspiration pneumonia? A prospective evaluation using a protected specimen brush and quantitative cultures. Intensive Care Med. 1993;19(5):279-84. [Medline].

  9. Moll J, Kerns W 2nd, Tomaszewski C. Incidence of aspiration pneumonia in intubated patients receiving activated charcoal. J Emerg Med. Mar-Apr 1999;17(2):279-83. [Medline].

  10. Pennza PT. Aspiration pneumonia, necrotizing pneumonia, and lung abscess. Emerg Med Clin North Am. May 1989;7(2):279-307. [Medline].

  11. Preston AJ, Gosney MA, Noon S. Oral flora of elderly patients following acute medical admission. Gerontology. Jan-Feb 1999;45(1):49-52. [Medline].

  12. Sasaki H, Sekizawa K, Yanai M. New strategies for aspiration pneumonia. Intern Med. Dec 1997;36(12):851-5. [Medline].

  13. Vadeboncoeur TF, Davis DP, Ochs M. The ability of paramedics to predict aspiration in patients undergoing prehospital rapid sequence intubation. J Emerg Med. Feb 2006;30(2):131-6. [Medline].

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Further Reading

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Contributor Information and Disclosures

Author

Anand Swaminathan, MD, Chief Resident Physician, Department of Emergency Medicine, New York University/Bellevue Hospital Center
Anand Swaminathan, MD is a member of the following medical societies: American Academy of Emergency Medicine, Emergency Medicine Residents Association, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Sassan Naderi, MD, Staff Physician, Department of Emergency Medicine, North Shore/Long Island Jewish Health System, Albert Einstein College of Medicine
Disclosure: Nothing to disclose.

Medical Editor

Dana A Stearns, MD, Assistant Director of Undergraduate Education, Department of Emergency Medicine, Massachusetts General Hospital
Dana A Stearns, MD is a member of the following medical societies: American Academy of Emergency Medicine and American College of Emergency Physicians
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Paul Blackburn, DO, FACOEP, FACEP, Program Director, Department of Emergency Medicine, Maricopa Medical Center; Assistant Professor, Department of Surgery, University of Arizona
Paul Blackburn, DO, FACOEP, FACEP is a member of the following medical societies: American College of Emergency Physicians, American College of Osteopathic Emergency Physicians, American Medical Association, and Arizona Medical Association
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Robert E O'Connor, MD, MPH, Professor and Chair, Department of Emergency Medicine, University of Virginia Health System
Robert E O'Connor, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Physician Executives, American Heart Association, American Medical Association, Medical Society of Delaware, National Association of EMS Physicians, Society for Academic Emergency Medicine, and Wilderness Medical Society
Disclosure: Nothing to disclose.

 
 
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