Aspiration pneumonia natural history, complications, and prognosis: Difference between revisions
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{{Aspiration pneumonia}} | {{Aspiration pneumonia}} | ||
{{CMG}}; {{AE}} {{SSH}} | |||
==Overview== | ==Overview== | ||
Aspiration pneumonia occurs following aspiration of different materials and particles. Natural history, complications, and prognosis are different for each category. [[Chemical pneumonitis]] usually develop after [[aspiration]] of [[gastric acid]] and might present acutely within two hours. Rapid clinical recovery or worsening of [[Respiratory failure|respiratory distress]] and [[hypoxemia]] might happen. [[Infection|Bacterial infection]] following aspiration is slower that other [[community-acquired pneumonia]] and might be acute, subacute, or chronic. [[Foreign body]] aspiration might present acutely with mechanical [[obstruction]] or [[chemical pneumonitis]]. Patients might present acutely with [[inflammation]] and [[cough]], [[fever]], and [[dyspnea]]. However, they might be [[asymptomatic]] and present with an incidental mass on radiographs. Complications of aspiration pneumonia include segmental or [[Pneumonia|lobar pneumonia]], [[bronchopneumonia]], [[bronchiectasis]], [[lung abscess]], [[pleural empyema]], [[respiratory failure]], [[bacteremia]], and [[shock]]. | |||
==Natural History, Complications, and Prognosis== | ==Natural History, Complications, and Prognosis== | ||
===Natural History=== | ===Natural History=== | ||
* Aspiration pneumonia occurs following aspiration of different materials and particles. Natural history, complications, and prognosis are different for each category.<ref name="pmid198572242">{{cite journal| author=Japanese Respiratory Society| title=Aspiration pneumonia. | journal=Respirology | year= 2009 | volume= 14 Suppl 2 | issue= | pages= S59-64 | pmid=19857224 | doi=10.1111/j.1440-1843.2009.01578.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19857224 }}</ref><ref name="pmid230520022">{{cite journal| author=Almirall J, Cabré M, Clavé P| title=Complications of oropharyngeal dysphagia: aspiration pneumonia. | journal=Nestle Nutr Inst Workshop Ser | year= 2012 | volume= 72 | issue= | pages= 67-76 | pmid=23052002 | doi=10.1159/000339989 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23052002 }}</ref><ref name="pmid9925081">{{cite journal| author=Marik PE, Careau P| title=The role of anaerobes in patients with ventilator-associated pneumonia and aspiration pneumonia: a prospective study. | journal=Chest | year= 1999 | volume= 115 | issue= 1 | pages= 178-83 | pmid=9925081 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9925081 }}</ref><ref name="pmid28270104">{{cite journal| author=Shen CF, Wang SM, Ho TS, Liu CC| title=Clinical features of community acquired adenovirus pneumonia during the 2011 community outbreak in Southern Taiwan: role of host immune response. | journal=BMC Infect Dis | year= 2017 | volume= 17 | issue= 1 | pages= 196 | pmid=28270104 | doi=10.1186/s12879-017-2272-5 | pmc=5341368 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28270104 }}</ref><ref name="pmid21311332">{{cite journal| author=Marik PE| title=Pulmonary aspiration syndromes. | journal=Curr Opin Pulm Med | year= 2011 | volume= 17 | issue= 3 | pages= 148-54 | pmid=21311332 | doi=10.1097/MCP.0b013e32834397d6 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21311332 }}</ref><ref name="pmid257324472">{{cite journal| author=Hu X, Lee JS, Pianosi PT, Ryu JH| title=Aspiration-related pulmonary syndromes. | journal=Chest | year= 2015 | volume= 147 | issue= 3 | pages= 815-823 | pmid=25732447 | doi=10.1378/chest.14-1049 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25732447 }}</ref><ref name="DiBardinoWunderink2015">{{cite journal|last1=DiBardino|first1=David M.|last2=Wunderink|first2=Richard G.|title=Aspiration pneumonia: A review of modern trends|journal=Journal of Critical Care|volume=30|issue=1|year=2015|pages=40–48|issn=08839441|doi=10.1016/j.jcrc.2014.07.011}}</ref><ref name="LanspaJones20132">{{cite journal|last1=Lanspa|first1=Michael J.|last2=Jones|first2=Barbara E.|last3=Brown|first3=Samuel M.|last4=Dean|first4=Nathan C.|title=Mortality, morbidity, and disease severity of patients with aspiration pneumonia|journal=Journal of Hospital Medicine|volume=8|issue=2|year=2013|pages=83–90|issn=15535592|doi=10.1002/jhm.1996}}</ref><ref name="Marik20012">{{cite journal|last1=Marik|first1=Paul E.|title=Aspiration Pneumonitis and Aspiration Pneumonia|journal=New England Journal of Medicine|volume=344|issue=9|year=2001|pages=665–671|issn=0028-4793|doi=10.1056/NEJM200103013440908}}</ref><ref name="pmid19857224">{{cite journal| author=Japanese Respiratory Society| title=Aspiration pneumonia. | journal=Respirology | year= 2009 | volume= 14 Suppl 2 | issue= | pages= S59-64 | pmid=19857224 | doi=10.1111/j.1440-1843.2009.01578.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19857224 }}</ref><ref name="pmid23052002">{{cite journal| author=Almirall J, Cabré M, Clavé P| title=Complications of oropharyngeal dysphagia: aspiration pneumonia. | journal=Nestle Nutr Inst Workshop Ser | year= 2012 | volume= 72 | issue= | pages= 67-76 | pmid=23052002 | doi=10.1159/000339989 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23052002 }}</ref> | |||
==== Chemical pneumonitis ==== | ==== Chemical pneumonitis ==== | ||
* The symptoms of chemical pneumonitis usually develop after [[aspiration]] of [[gastric acid]]. | * The symptoms of [[chemical pneumonitis]] usually develop after [[aspiration]] of [[gastric acid]]. | ||
*Following aspiration, | *Following aspiration, onset of [[Respiratory failure|respiratory distress]] and [[cyanosis]] occurs within 2 hours. | ||
*The clinical course following chemical pneumonitis might be rapid clinical recovery or worsening of [[Respiratory failure|respiratory distress]] and [[hypoxemia]]. | *The clinical course following [[chemical pneumonitis]] might be rapid clinical recovery or worsening of [[Respiratory failure|respiratory distress]] and [[hypoxemia]]. | ||
*Pulmonary fibrosis might happen even after recovery. | *[[Pulmonary fibrosis]] might happen even after recovery. | ||
==== Bacterial infection ==== | ==== Bacterial infection ==== | ||
*Bacterial infection following aspiration is slower that other community-acquired pneumonia. | *[[Infection|Bacterial infection]] following aspiration is slower that other [[community-acquired pneumonia]]. | ||
*Cough, fever, purulent sputum, and dyspnea are typical symptoms of aspiration pneumonia. | *[[Cough]], [[fever]], purulent [[sputum]], and [[dyspnea]] are typical symptoms of aspiration pneumonia. | ||
*Anaerobic infections | *[[Anaerobic respiration|Anaerobic]] infections may last several days or weeks and the patients may present with [[anemia]] and [[weight loss]]. | ||
* | *Later, the patients may present with following complications including [[lung abscess]], necrotizing [[pneumonia]], or [[empyema]]. | ||
==== Foreign body aspiration ==== | ==== Foreign body aspiration ==== | ||
* Foreign body aspiration might present acutely with mechanical obstruction or chemical pneumonitis. | * [[Foreign body]] aspiration might present acutely with mechanical [[obstruction]] or [[chemical pneumonitis]]. | ||
* Foreign body aspiration is more common in children from one to three years of age. | * [[Foreign body]] aspiration is more common in children from one to three years of age. | ||
* | * [[Foreign body]] might be visualized on chest radiographs. | ||
* The Heimlich maneuver is recommended. | * The [[Choking|Heimlich maneuver]] is recommended to remove [[foreign body]] from [[respiratory tract]]. | ||
==== Lipoid Pneumonia ==== | |||
* [[Lipid pneumonia|Lipoid pneumonia]] might happen following aspiration of [[oil]]. | |||
* Patients might present acutely with [[inflammation]] and [[cough]], [[fever]], and [[dyspnea]]. However, they might be [[asymptomatic]] and present with an incidental mass on radiographs. | |||
===Complications=== | ===Complications=== | ||
* | *Complications of aspiration pneumonia include: | ||
** Segmental or [[Pneumonia|lobar pneumonia]] | ** Segmental or [[Pneumonia|lobar pneumonia]] | ||
** [[Bronchopneumonia]] | ** [[Bronchopneumonia]] | ||
** [[Bronchiectasis]] | ** [[Bronchiectasis]] | ||
** [[Lung abscess]] | ** [[Lung abscess]] | ||
** [[ | ** [[Pleural empyema]] | ||
** [[Respiratory failure]] | ** [[Respiratory failure]] | ||
** [[Bacteremia]] | ** [[Bacteremia]] | ||
| Line 40: | Line 47: | ||
===Prognosis=== | ===Prognosis=== | ||
*Aspiration pneumonia prognosis is generally good, and | *Aspiration pneumonia prognosis is generally good, and [[mortality rate]] of patients with aspiration pneumonia is approximately 10.6-21%.<ref name="LanspaJones20132">{{cite journal|last1=Lanspa|first1=Michael J.|last2=Jones|first2=Barbara E.|last3=Brown|first3=Samuel M.|last4=Dean|first4=Nathan C.|title=Mortality, morbidity, and disease severity of patients with aspiration pneumonia|journal=Journal of Hospital Medicine|volume=8|issue=2|year=2013|pages=83–90|issn=15535592|doi=10.1002/jhm.1996}}</ref> | ||
*The presence of underlying [[Neurology|neurologic diseases]] that affect [[cough reflex]] is associated with a particularly poor prognosis among patients with aspiration pneumonia. | |||
*The presence of [ | |||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
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[[Category:Medicine]] | |||
[[Category:Pulmonology]] | |||
[[Category: | [[Category:Up-To-Date]] | ||
[[Category:Emergency medicine]] | |||
Latest revision as of 20:29, 29 July 2020
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sadaf Sharfaei M.D.[2]
Overview
Aspiration pneumonia occurs following aspiration of different materials and particles. Natural history, complications, and prognosis are different for each category. Chemical pneumonitis usually develop after aspiration of gastric acid and might present acutely within two hours. Rapid clinical recovery or worsening of respiratory distress and hypoxemia might happen. Bacterial infection following aspiration is slower that other community-acquired pneumonia and might be acute, subacute, or chronic. Foreign body aspiration might present acutely with mechanical obstruction or chemical pneumonitis. Patients might present acutely with inflammation and cough, fever, and dyspnea. However, they might be asymptomatic and present with an incidental mass on radiographs. Complications of aspiration pneumonia include segmental or lobar pneumonia, bronchopneumonia, bronchiectasis, lung abscess, pleural empyema, respiratory failure, bacteremia, and shock.
Natural History, Complications, and Prognosis
Natural History
- Aspiration pneumonia occurs following aspiration of different materials and particles. Natural history, complications, and prognosis are different for each category.[1][2][3][4][5][6][7][8][9][10][11]
Chemical pneumonitis
- The symptoms of chemical pneumonitis usually develop after aspiration of gastric acid.
- Following aspiration, onset of respiratory distress and cyanosis occurs within 2 hours.
- The clinical course following chemical pneumonitis might be rapid clinical recovery or worsening of respiratory distress and hypoxemia.
- Pulmonary fibrosis might happen even after recovery.
Bacterial infection
- Bacterial infection following aspiration is slower that other community-acquired pneumonia.
- Cough, fever, purulent sputum, and dyspnea are typical symptoms of aspiration pneumonia.
- Anaerobic infections may last several days or weeks and the patients may present with anemia and weight loss.
- Later, the patients may present with following complications including lung abscess, necrotizing pneumonia, or empyema.
Foreign body aspiration
- Foreign body aspiration might present acutely with mechanical obstruction or chemical pneumonitis.
- Foreign body aspiration is more common in children from one to three years of age.
- Foreign body might be visualized on chest radiographs.
- The Heimlich maneuver is recommended to remove foreign body from respiratory tract.
Lipoid Pneumonia
- Lipoid pneumonia might happen following aspiration of oil.
- Patients might present acutely with inflammation and cough, fever, and dyspnea. However, they might be asymptomatic and present with an incidental mass on radiographs.
Complications
- Complications of aspiration pneumonia include:
Prognosis
- Aspiration pneumonia prognosis is generally good, and mortality rate of patients with aspiration pneumonia is approximately 10.6-21%.[8]
- The presence of underlying neurologic diseases that affect cough reflex is associated with a particularly poor prognosis among patients with aspiration pneumonia.
References
- ↑ Japanese Respiratory Society (2009). "Aspiration pneumonia". Respirology. 14 Suppl 2: S59–64. doi:10.1111/j.1440-1843.2009.01578.x. PMID 19857224.
- ↑ Almirall J, Cabré M, Clavé P (2012). "Complications of oropharyngeal dysphagia: aspiration pneumonia". Nestle Nutr Inst Workshop Ser. 72: 67–76. doi:10.1159/000339989. PMID 23052002.
- ↑ Marik PE, Careau P (1999). "The role of anaerobes in patients with ventilator-associated pneumonia and aspiration pneumonia: a prospective study". Chest. 115 (1): 178–83. PMID 9925081.
- ↑ Shen CF, Wang SM, Ho TS, Liu CC (2017). "Clinical features of community acquired adenovirus pneumonia during the 2011 community outbreak in Southern Taiwan: role of host immune response". BMC Infect Dis. 17 (1): 196. doi:10.1186/s12879-017-2272-5. PMC 5341368. PMID 28270104.
- ↑ Marik PE (2011). "Pulmonary aspiration syndromes". Curr Opin Pulm Med. 17 (3): 148–54. doi:10.1097/MCP.0b013e32834397d6. PMID 21311332.
- ↑ Hu X, Lee JS, Pianosi PT, Ryu JH (2015). "Aspiration-related pulmonary syndromes". Chest. 147 (3): 815–823. doi:10.1378/chest.14-1049. PMID 25732447.
- ↑ DiBardino, David M.; Wunderink, Richard G. (2015). "Aspiration pneumonia: A review of modern trends". Journal of Critical Care. 30 (1): 40–48. doi:10.1016/j.jcrc.2014.07.011. ISSN 0883-9441.
- ↑ 8.0 8.1 Lanspa, Michael J.; Jones, Barbara E.; Brown, Samuel M.; Dean, Nathan C. (2013). "Mortality, morbidity, and disease severity of patients with aspiration pneumonia". Journal of Hospital Medicine. 8 (2): 83–90. doi:10.1002/jhm.1996. ISSN 1553-5592.
- ↑ Marik, Paul E. (2001). "Aspiration Pneumonitis and Aspiration Pneumonia". New England Journal of Medicine. 344 (9): 665–671. doi:10.1056/NEJM200103013440908. ISSN 0028-4793.
- ↑ Japanese Respiratory Society (2009). "Aspiration pneumonia". Respirology. 14 Suppl 2: S59–64. doi:10.1111/j.1440-1843.2009.01578.x. PMID 19857224.
- ↑ Almirall J, Cabré M, Clavé P (2012). "Complications of oropharyngeal dysphagia: aspiration pneumonia". Nestle Nutr Inst Workshop Ser. 72: 67–76. doi:10.1159/000339989. PMID 23052002.