ASPIRATION PNEUMONIA

MUHAMMAD ILYAS
DEPARTEMEN PULMONOLOGI DAN KEDOKTERAN RESPIRASI
FAKULTAS KEDOKTERAN UNIVERSITAS HASANUDDIN
RS DR. WAHIDIN SUDIROHUSODO
Structure and Function
 Pneumonia: Classifications
Community-acquired pneumonia (CAP)
Onset in community or during 1st 2 days of hospitalization
(Strep. pneumoniae most common)

Hospital-acquired Pneumonia(HAP/nosocomial)
Occurring 48 hrs or longer after hospitalization

Aspiration pneumonia

Pneumonia caused by opportunistic organisms

Pneumocystis Carinii
Aspiration is defined as the
inhalation of either oropharyngeal
or gastric contents into the lower
airways, that is, the act of taking
foreign material into the lungs
 Lower respiratory
infection caused
by oral bacteria
entering the lungs
via the trachea
instead of entering
the stomach via
the esophagus
 There are four types of aspiration
syndromes :
1.Gastric acid causes a chemical
pneumonitis (Mendelson's syndrome)
2.Bacteria from oral and pharyngeal areas
causes aspiration pneumonia
3. Oil (eg, mineral oil or vegetable oil)
causes exogenous lipoid pneumonia
4. A foreign body may cause an acute
respiratory emergency and, in some
cases, may predispose the patient to
bacterial pneumonia.
 Aspiration pneumonia referred to an
infection caused by less virulent
bacteria, primarily oral pharyngeal
anaerobes. It is now recognized that
the many common community-
acquired and hospital-acquired
pneumonias result from the aspiration
of pathogans from the oral cavity or
nasopharynx.
 PATHOPHYSIOLOGY
The lower oesophageal sphincter (LOS) is
functionally distinct from the oesophagus,
and acts as a valve preventing the reflux of
gastric contents. Barrier pressure is the
difference between LOS pressure(N= 20-
30mmHg) and intragastric pressure (N= 5-
10mmHg) and both are influenced by a
number of factors.
The resulting drop in barrier pressure may
increase the risk of aspiration
 Pathophysiology

Aspiration of infected particles from gastric contents, food, or

debris
commonly cause these pneumonias
Streptococus pneumoniae,
Haemophilus influenza,
Staphlococcus aureus, and
gram-negative bacteria
 WHY WE CARE ?

It is the leading cause of death

from infections acquired in a
Healthcare setting (HAI).
 WHY WE CARE ?

It is the leading cause of death from

infections acquired in a Healthcare setting
(HAI).
There is a 21% mortality rate for anyone
getting AP
That means one of every five patients
with AP will die from it
 WHY WE CARE ?

It is the leading cause of death from infections

acquired in a Healthcare setting (HAI).
There is a 21% mortality rate for anyone
getting AP
That rises to 30% if it is an HAI.
That means almost one of every three patients
who gets AP in a healthcare setting will die from
it.
 RISK FACTOR
Everyone with a mouth!
Lowered immune response
Altered Consciousness Head trauma
Alcohol use
Medication Side Effect
Medication Overdose
Seizures
Recent General Anesthesia
 RISK FACTOR (contd)

Dysphagia
GERD (especially if taking PPIs)
Neurologic disorders (e.g., MS,
Parkinsons, dementia
 NG tube
G-tube

Recent Gastric

endoscopy
Recent

intubation
 Other Conditions:
Prolonged vomiting
General Deconditioning
Prolonged
Recumbence
Critical Illness
Dehydration
(decreased salivation)
Diabetes (decreased
gastric emptying
Everyone is at risk! But not every
one gets sick.

Severity of Aspiration Pneumonia is

determined by three criteria:

1. What is being aspirated.

2. How much is being aspirated
3.How sick the patient already is.
 SIGNS AND SYMPTOMS OF
ASPIRATION
Coughing, gagging, choking
Changes in respiratory status
Vital signs and oxygen saturation
beyond suggested limits
Increased secretions
Generalized distress
 Clinical Manifestations
Fevers, chills, anorexia
Pleuritic chest pain
Crackles/wheezes
Cough, sputum production
Tachypnea
 Pneumonia: Diagnosis

Diagnosis
Physical exam

crackles,
rhonchi/wheezes

CXR area of increased LUL Infiltrates

density
(infiltrates/ consolidation)

Sputum specimen
Gram stain
 CXR
Aspiration pneumonia
in an 84-year-old man
in generally good
health who had fever
and cough. This
posteroanterior
radiograph
demonstrates a left
lower lobe opacity
The goal of preventive
measures is to reduce risk from
these three criteria
 Treatment of
Aspiration Pneumonia

The first step in the treatment of aspiration

pneumonia is proper respiratory care
and prevention of respiratory failure.
Food debris and other materials that may
cause airway obstruction should be
removed through transbronchial
suctioning earliest
 Pneumonia :Interventions/Tx
Treatment
Antibiotics choose based on age,

suspected cause & immune status

Supportive care IV fluids, supplemental

oxygen therapy, respiratory monitoring,
cough enhancement

*may take 6-8 weeks for CXR to normalize

 The selection of antibiotics
1. Broad spectrum of activity
2. Stability against lactamase
3. Awareness of the fact that more and more
strains of bacteria are acquiring resistance
that does not depend on the production of
-lactamases
4.The extent of drug penetration into airway
foci
5.The severity of adverse effects
 Factors may influence the
severity of aspiration pneumonia

1. The number of episodes of aspiration

2. The degree of airway obstruction
3. Aspiration of massive amounts of
indigenous microbial flora alone, or of
a mixture of pathogenic organisms
4. Failure of initial therapy
 Complications

Hypoxemia

Pleural effusion Atelectasis Pleurisy

Atelectasis

Pleurisy

Pleural Effusion
 CONCLUSION
Aspiration Pneumonia follows a chain
of events. This usually includes a major
medical event, then a compromised
immune response and diminished
swallow ability.
The overgrowth of oral bacteria and the
aspiration of those secretions leads to
the illness.
Thank you