Aspiration pneumonia and pneumonitis: Difference between revisions

Revision as of 00:08, 24 July 2011

Background

Difficult to predict which pts with pneumonitis will go on to develop PNA
Aspiration pneumonitis
- Inflammatory chemical injury of tracheobronchial tree and pulmonary parenchyma
  - Due to inhalation of regurgitated sterile gastric contents
    - Must aspirate at least 20-30mL of gastric contents with pH <2.5
  - Can lead to aspiration PNA d/t pulmonary defense mechanism injury
Aspiration pneumonia
- Alveolar space infection d/t inhalation of pathogenic material from oropharynx
  - Increased in pts w/ periodontal dz, chronic colonization of upper airways, PPI/H2 meds
- Accounts for up to 20% of CAP in elderly, majority of nursing home-acquired PNA
- Microbiology
  - Community acquired: Pneumococcus, staph, H flu, enterobacter
  - Hospital acquired: Pseudomonas, gram-negatives

Diagnosis

Aspiration pneumonitis
- Cough, tachypnea, bloody sputum, respiratory distress
Aspiration PNA
- Fever, dyspnea, productive cough, Tachypnea, tachycardia, AMS
- CXR
  - Unilateral focal or patchy consolidations in dependent lung segments
    - Right lower lobe is most common area; bilateral patterns can also be seen

Work-Up

CXR

Treatment

Aspiration pneumonitis
- Suction upper airway if aspiration is witnessed
- Abx
  - Only recommended if symptoms persist >48hr
    - Levo/moxifloxacin or clindamycin or amoxicillin-clavulanate
Aspiration pneumonia
- Community-acquired
  - Moxifloxacin or clinda or amoxicillin-clavulanate
- Health care-associated or periodontal disease or alcoholism
  - CTX + clindamycin OR
  - Piperacillin-tazobactam + clindamycin OR
  - Ampicillin-sulbactam + clindamycin OR
  - Cefepime + clindamycin OR
  - Levofloxacin + clindamycin

Disposition

Healthy person
- Observe for 1hr; if asymptomatic discharge
- If mild-moderate symptoms develop and persist >48hr treat with antibiotics
Chronically ill or nursing home pt
- Consider ED obs unit versus short admission for observation +/- prophylactic abx
Admit all pts w/ aspiration PNA

Source

Tintinalli

Authors:

@@ Line 1: / Line 1: @@
 ==Background==
+*Difficult to predict which pts with pneumonitis will go on to develop PNA
+*Aspiration pneumonitis
+**Inflammatory chemical injury of tracheobronchial tree and pulmonary parenchyma
+***Due to inhalation of regurgitated sterile gastric contents
+****Must aspirate at least 20-30mL of gastric contents with pH <2.5
+***Can lead to aspiration PNA d/t pulmonary defense mechanism injury
+*Aspiration pneumonia
+**Alveolar space infection d/t inhalation of pathogenic material from oropharynx
+***Increased in pts w/ periodontal dz, chronic colonization of upper airways, PPI/H2 meds
+**Accounts for up to 20% of CAP in elderly, majority of nursing home-acquired PNA
+**Microbiology
+***Community acquired: Pneumococcus, staph, H flu, enterobacter
+***Hospital acquired: Pseudomonas, gram-negatives
 ==Diagnosis==
+*Aspiration pneumonitis
+**Cough, tachypnea, bloody sputum, respiratory distress
+*Aspiration PNA
+**Fever, dyspnea, productive cough, Tachypnea, tachycardia, AMS
+**CXR
+***Unilateral focal or patchy consolidations in dependent lung segments
+****Right lower lobe is most common area; bilateral patterns can also be seen
 ==Work-Up==
+*CXR
-==DDx==
 ==Treatment==
+*Aspiration pneumonitis
+**Suction upper airway if aspiration is witnessed
+**Abx
+***Only recommended if symptoms persist >48hr
+****Levo/moxifloxacin or clindamycin or amoxicillin-clavulanate
+*Aspiration pneumonia
+**Community-acquired
+***Moxifloxacin or clinda or amoxicillin-clavulanate
+**Health care-associated or periodontal disease or alcoholism
+***CTX + clindamycin OR
+***Piperacillin-tazobactam + clindamycin OR
+***Ampicillin-sulbactam + clindamycin OR
+***Cefepime + clindamycin OR
+***Levofloxacin + clindamycin
 ==Disposition==
+*Healthy person
+**Observe for 1hr; if asymptomatic discharge
+**If mild-moderate symptoms develop and persist >48hr treat with antibiotics
+*Chronically ill or nursing home pt
+**Consider ED obs unit versus short admission for observation +/- prophylactic abx
+*Admit all pts w/ aspiration PNA
 ==See Also==
+[[Pneumonia (Main)]]
 ==Source==
+Tintinalli
+[[Category:ID]]
-[[Category:WikEM]]
+[[Category:Pulm]]