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Acute aspiration

Last reviewed: 6 Oct 2024
Last updated: 01 Sep 2020

Summary

Definition

History and exam

Key diagnostic factors

  • intractable cough
  • fever
  • dyspnea
  • wheezing
  • crackles
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
Full details

Treatment algorithm

ACUTE

pneumonitis due to aspiration of gastric contents

pneumonitis due to aspiration of barium

ONGOING

nonresolving pneumonitis after 48 hours

Contributors

Authors

Madison Macht, MD

Volunteer Clinical Faculty

Division of Pulmonary Sciences and Critical Care Medicine

University of Colorado Denver

Aurora

CO

Disclosures

MM declares that he has no competing interests.

Acknowledgements

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.

Disclosures

KM, SS, SM, and HC declare that 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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