Degenerative neurologic diseases (e.g. dementia, post-stroke, Parkinson’s Disease, multiple sclerosis)
Anatomical abnormality or mechanical interference of upper gastrointestinal tract (e.g. enteral feeding, nasogastric tube, endotracheal intubation)
Esophageal disorders (e.g. strictures, vomiting + small bowel obstruction, achalasia)
Altered level of consciousness (e.g. acute alcohol or substance abuse, seizures, CNS depressants, etc.)
Inflammatory response to chemical injury caused by inhalation of sterile gastric contents.
Episode of macroaspiration is often witnessed and typically occurs in patients with decreased level of consciousness.
Characterized by a sudden onset of prominent dyspnea, tachycardia, hypoxemia, low-grade fever, and crackles or diffuse wheeze
Symptoms may range from mild to severe and can develop within 2 to 5 hours
Pulmonary infiltrates are apparent on x-ray
Usually a clinical diagnosis in a patient with predisposing risk factors to aspiration, compatible radiographic evidence occurring in dependant lung segment and characteristic clinical history indicative of infection (e.g. fever, cough, etc.).
Episode of aspiration often not witnessed.
Right lower lobe most commonly implicated in ambulatory patients. Posterior upper and superior lower lobes most commonly implicated in bed bound patients.
Guideline content derived from:
- NB Provincial Health Authorities Anti-Infective Stewardship Committee. Antimicrobial Therapy for Adult Aspiration Pneumonia. 10-2020.
- DiBardino DM, Wunderink RG. Aspiration pneumonia: A review of modern trends. J Crit Care. 2015 Feb;30(1):40-8.
- Marik PE. Aspiration pneumonitis and aspiration pneumonia. N Engl J Med. 2001 Mar 1;344(9):665-71.
- Japanese Respiratory Society. Aspiration Pneumonia. Respirology. 2009 Nov;14 Suppl 2:S59-64.
- Komiya K, Ishii H, Kadota J. Healthcare-associated Pneumonia and Aspiration Pneumonia. Aging Dis. 2014 Feb 8;6(1):27-37.
- Blondel-Hill E, Fryters S. Bugs & Drugs App. Edmonton: Capital Health (Accessed August 8, 2019)
- Bartlett JG. Aspiration Pneumonia in Adults. In: UpToDate, Sexton DJ (Ed), UpToDate, Waltham, MA. (Accessed on August 8, 2019.)
- Vlad Dragan, Yanliang Wei, Marion Elligsen, Alex Kiss, Sandra A N Walker, Jerome A Leis, Prophylactic Antimicrobial Therapy for Acute Aspiration Pneumonitis, Clinical Infectious Diseases, Volume 67, Issue 4, 15 August 2018, Pages 513–518, https://doi.org/10.1093/cid/ciy120
- Spectrum Mobile Health App. Eastern Health St. Johns; Island Health Vancouver; AHS Calgary Zone; Fraser Health BC; Providence Health Care Vancouver; Saskatchewan Health Authority. (Accessed August 8, 2019)
- Mandell LA, Niederman MS. Aspiration Pneumonia. New England Journal of Medicine. 2019;380(7):651-663.