Acute aspiration is the inhalation of foreign material into the airways beyond the vocal cords.
Usually occurs in patients with risk factors such as swallowing dysfunction, impaired conscious level, or substance misuse.
Patients with risk factors for acute aspiration should undergo a bedside clinical examination before feeding.
Patients undergoing a general anaesthetic are also at risk of acute aspiration. Anaesthesia-related aspiration can be prevented by identifying patients susceptible to vomiting and reflux, minimising gastric contents before surgery, minimising emetic stimuli, and avoiding complete loss of protective reflexes from over-sedation.
Antibiotics are not indicated early after aspiration, but they should be considered if the pneumonitis does not resolve after 48 hours.
Patients with neurological deficits, infants (not covered in the topic), older patients (aged >70 years), and debilitated patients with dysphagia may also aspirate barium sulfate during radiological procedures, which can result in severe pneumonitis.
Screening for dysphagia is recommended for patients at risk of, or following, aspiration due to suspected dysphagia (including all patients following an acute stroke), which should involve a swallowing assessment initially, and input from the multidisciplinary team.
Aspiration is the inhalation of liquid or solid particles, particularly gastric contents or food and drink, into the airways beyond the vocal cords. It can lead to aspiration pneumonitis or aspiration pneumonia. Aspiration pneumonitis is a chemical injury after aspiration of gastric contents. Aspiration pneumonia is an infectious process secondary to aspiration of orogastric contents colonised with bacteria. However, not all episodes of aspiration lead to an infection.
This topic covers acute aspiration in adults. It does not discuss the inhalation of foreign bodies – see our topic Foreign body aspiration.
History and exam
Key diagnostic factors
- presence of risk factors
- intractable cough
- reduced conscious level
- swallowing dysfunction
- cerebrovascular disease
- impaired conscious level (Glasgow coma scale score <9)
- substance misuse
- during general anaesthesia (or other oropharyngeal procedures) or in the intensive care unit
- gastrointestinal disorder
- older age
- poor cough
- increased severity of illness
- upper gastrointestinal studies with barium
- male sex
- presence of a feeding tube
- head and neck cancers
- gastro-oesophageal reflux disease
- supine position
- drugs that reduce oesophageal sphincter tone
1st investigations to order
- chest x-ray
- blood tests
Investigations to consider
- chest CT
- arterial blood gas
pneumonitis due to aspiration
non-resolving pneumonitis after 48 hours
Jonathan Bennett, MD
Honorary Professor of Respiratory Sciences
University of Leicester
JB is deputy medical director of RCP Invited Service Reviews, and speaker at national meetings for organisations including the British Thoracic Society, Primary Care Respiratory Society, and Society for Cardiothoracic Surgery.
JB declares that he has no competing interests.
Melvyn Jenkins-Welch, MBBS, BSc, MSc, FRCA, FFICM
Consultant Critical Care Medicine
Cardiff and Vale ULHB
MJW declares that he has no competing interests.
BMJ Best Practice would like to gratefully acknowledge the previous expert contributor, whose work has been retained in parts of the content:
Madison Macht, MD
Volunteer Clinical Faculty
Division of Pulmonary Sciences and Critical Care Medicine
University of Colorado Denver
David G. Smithard, BSc, MB, MD, FRCP, FRCSLT (Hon)
University of Greenwich
Consultant in Elderly Medicine
Queen Elizabeth Hospital
Lewisham and Greenwich NHS Trust
DGS declares that he has no competing interests.
Section Editor and Comorbidities Editor, BMJ Best Practice
AS declares that she has no competing interests.
Lead Section Editor, BMJ Best Practice
RW declares that she has no competing interests.
Drug Editor, BMJ Best Practice
AM declares that he has no competing interests.
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