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Acute aspiration

Last reviewed: 3 Mar 2025
Last updated: 25 Mar 2025

Summary

Definition

History and exam

Key diagnostic factors

  • acute or chronic cough
  • fever
  • dyspnea
  • wheezing
  • crackles
Full details

Other diagnostic factors

  • laryngospasm
Full details

Risk factors

  • decreased level of consciousness (Glasgow coma scale score <9)
  • increased severity of illness
  • general anesthesia
  • age >70 years
  • male sex
  • head trauma
  • cerebrovascular disease
  • endotracheal or tracheostomy tube
  • dysphagia
  • airway difficulties
  • barium meal
  • gastroesophageal reflux disease
  • feeding tubes
  • supine position
  • delayed gastric emptying
  • obesity
  • drugs that reduce esophageal sphincter tone
Full details

Diagnostic tests

1st tests to order

  • chest x-ray
Full details

Tests to consider

  • chest CT
  • bronchoscopy with bronchoalveolar lavage
  • CBC
  • arterial blood gases
  • blood culture
  • thoracentesis
Full details

Treatment algorithm

ACUTE

pneumonitis due to aspiration of gastric contents

pneumonitis due to aspiration of barium

Contributors

Authors

Augustine Lee, MD

Professor of Medicine

Division of Pulmonary and Critical Care Medicine

Mayo Clinic Florida

Jacksonville

FL

Disclosures

AL declares that he has no competing interests.

Spencer Deleveaux, MBBS

Fellow

Division of Pulmonary and Critical Care Medicine

Mayo Clinic Florida

Jacksonville

FL

Disclosures

SD declares that he has no competing interests.

Acknowledgements

Dr Augustine Lee and Dr Spencer Deleveaux would like to gratefully acknowledge Dr Madison Macht, Dr Kamran Mahmood, Dr Scott Shofer, Dr Septimiu Murgu, and Dr Henri Colt, previous contributors to this topic.

Disclosures

MM, KM, SS, SM, and HC declare they have no competing interests.

Peer reviewers

Andrew Parfitt, MBBS, FFAEM

Clinical Director

Acute Medicine

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

London

UK

Disclosures

AP declares that he has no competing interests.

Momen M. Wahidi, MD, MBA

Director

Interventional Pulmonology

Division of Pulmonary, Allergy, and Critical Care Medicine

Assistant Professor of Medicine

Duke University Medical Center

Durham

NC

Disclosures

MMW declares that he has no competing interests.

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