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Aspiration pneumonitis
- Observed or suspected vomiting in the context of loss of consciousness may lead to macro-aspiration of vomitus. Stomach content is acidic and causes chemical lung injury, which does not respond to antimicrobials.
- Defer antimicrobials for 48 hours, even if initial chest radiograph shows signs of consolidation or the patient requires supplementary oxygen.
- If respiratory failure and consolidation persist or worsen after 48 hours of observation, treat as CAP or HAP depending on duration of stay.
- Specific anaerobic cover, e.g. by adding metronidazole, is not recommended.
Aspiration pneumonia
- True aspiration pneumonia is usually caused by chronic micro-aspiration from the oro-pharynx due to incompetent swallow.
- Risk factors are listed below.
- Treat as CAP or HAP depending on duration of stay.
- Specific anaerobic cover, e.g. by adding metronidazole, is not recommended.
Risk factors for chronic aspiration:
- Age >60 years, particularly if in long-term residential care
- Prolonged supine position
- Malnutritional states:
- Upper GI conditions:
- Gastro-oesophgeal reflux, hiatus hernia, achalasia, oesophageal strictures
- Gastroparesis
- Learning difficulties or dementia
- Delirium
- Reduced level of consciousness due to medications, recreational drugs, or alcohol excess
- Neurological diseases affecting bulbar function, coordination, or muscular strength
- Laryngeal disease, e.g. vocal cord palsy and head and neck cancers
- Poor oral hygiene
- Instrumentation of the airway or upper GI tract:
- NG or NJ tube feeding
- PEG or PEJ tubes
- Endo-tracheal tube, laryngeal mask airway, naso-tracheal tube
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