The inhalation of foreign material into the airways beyond the vocal cords.
Usually occurs in patients with altered level of consciousness, dysphagia, or impaired cough reflex.
Patients with risk factors for aspiration should undergo a bedside clinical examination before feeding.
Anaesthesia-related aspiration of gastric contents 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 of gastric contents, but they should be considered if the pneumonitis does not resolve after 48 hours.
Patients with neurological deficits, infants, older patients (aged >70 years), and debilitated patients with dysphagia may also aspirate barium sulfate during radiological procedures, which can result in severe pneumonitis.
Aspiration is the inhalation of liquid or solid particles, particularly food, into the airways beyond the vocal cords. It can be categorised as 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. This topic does not discuss the inhalation of foreign bodies.
History and exam
- decreased level of consciousness (Glasgow coma scale score <9)
- increased severity of illness
- general anaesthesia
- age >70 years
- male sex
- head trauma
- cerebrovascular disease
- endotracheal or tracheostomy tube
- airway difficulties
- barium meal
- gastro-oesophageal reflux disease
- feeding tubes
- supine position
- delayed gastric emptying
- drugs that reduce oesophageal sphincter tone
Madison Macht, MD
Volunteer Clinical Faculty
Division of Pulmonary Sciences and Critical Care Medicine
University of Colorado Denver
MM declares that he has no competing interests.
Dr Madison Macht would like to gratefully acknowledge Dr Kamran Mahmood, Dr Scott Shofer, Dr Septimiu Murgu, and Dr Henri Colt, previous contributors to this topic.
KM, SS, SM, and HC declare that they have no competing interests.
Andrew Parfitt, MBBS, FFAEM
Associate Medical Director
Consultant Emergency Medicine
Guy's and St Thomas' NHS Foundation Trust
Clinical Lead and Consultant
Accident and Emergency Medicine
St Thomas' Hospital
AP declares that he has no competing interests.
Momen M. Wahidi, MD, MBA
Division of Pulmonary, Allergy, and Critical Care Medicine
Assistant Professor of Medicine
Duke University Medical Center
MMW declares that he has no competing interests.
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