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 exam before feeding.
Anesthesia-related aspiration of gastric contents can be prevented by identifying patients susceptible to vomiting and reflux, minimizing gastric contents before surgery, minimizing emetic stimuli, and avoiding complete loss of protective reflexes from oversedation.
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 neurologic deficits, infants, older patients (age >70 years), and debilitated patients with dysphagia may also aspirate barium sulfate during radiologic 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 categorized 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 colonized with bacteria. This topic does not discuss the inhalation of foreign bodies.
History and exam
Key diagnostic factors
- intractable cough
- 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
- airway difficulties
- barium meal
- gastroesophageal reflux disease
- feeding tubes
- supine position
- delayed gastric emptying
- drugs that reduce esophageal sphincter tone
1st investigations to order
- chest x-ray
Investigations to consider
- chest CT
- bronchoscopy with bronchoalveolar lavage
- arterial blood gases
pneumonitis due to aspiration of gastric contents
pneumonitis due to aspiration of barium
nonresolving pneumonitis after 48 hours
- Acute respiratory distress syndrome
- Asthma exacerbation
- Cystic fibrosis with exacerbation
- Diagnosis and treatment of adults with community-acquired pneumonia: an official clinical practice guideline
- ACR appropriateness criteria: dysphagia
- Log in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer