what causes aspiration pneumonia
Hispanics have a lower risk of death than non-Hispanics. In one cohort of aspiration pneumonia patients, overall three-year mortality was 40%. Aspiration pneumonia can also occur when food backs up or regurgitates from the stomach … seizure. Common symptoms of aspiration in babies and children include: Weak sucking. There have been several practices associated with decreased incidence and decreased severity of aspiration pneumonia as detailed below. [21] Whereas the use of antibiotics focuses on destroying and hindering the growth of bacteria, mechanical removal of oral bacteria by a dental professional also plays a key role in reducing the bacterial burden. Bacteria involved in aspiration pneumonia may be either aerobic or anaerobic. Risk Factors for Aspiration Pneumonia . When you eat, muscles push food and liquids from your throat through your esophagus, the muscular tube connecting the mouth to the stomach. Certain risk factors predispose individuals to aspiration, especially conditions causing dysfunction of the upper gastrointestinal system. problems with the nerves (neurological disorders) throat cancer. Dietary modifications or nothing-by-mouth status also have no effect on a patient's ability to handle their own secretions. [21] By reducing the amount of bacteria in the mouth, the likelihood of infection when aspiration occurs is reduced as well. It may be food, liquid, or some other material. Germs from food particles, saliva, vomit, or other substances that infect the airways and cause pneumonia in the aspiration phase. Aspiration pneumonia is a condition where foreign material enters the lower airways thereby causing inflammation of the lung. Aspiration pneumonia is a type of lung infection that is due to a relatively large amount of material from the stomach or mouth entering the lungs. While studies have suggested that thickening liquids can decrease aspiration through slowed pharyngeal transit time, they have also demonstrated increased pharyngeal residues with risk for delayed aspiration. [8], Many people at risk for aspiration pneumonia have an impaired swallowing mechanism, which may increase the chance of aspiration of food particles with meals. [23] It is recommended that patients fast prior to procedures as well. Radiological review shows chronic inflammation in the consolidated lung tissue, linking chronic micro-aspiration and chronic lung inflammation. Your health 2. [26] Owing to multiple factors, such as frailty, impaired efficacy of swallowing, decreased cough reflex and neurological complications, dysphagia can be considered as a geriatric syndrome. Depending on the composition of the aspirate, three complications have been described:[3], The location is often gravity dependent, and depends on the person's position. Being less alert due to medicines, illness, surgery, or other reasons 2. [3], The main treatment of aspiration pneumonia revolves around the use of antibiotics to remove the bacteria causing the infection. [18] The inflammation caused by this reaction can rapidly cause similar findings seen in aspiration pneumonia, such as an elevated WBC (white blood cell) count, radiologic findings, and fever. Aspiration pneumonia is caused by food, liquid or vomit that makes its way down the trachea into the lungs. Aspiration pneumonia was the most common reason for the emergency admission of patients with Parkinson's Disease whose disease duration was >5 years and pneumonia was one of the main causes of death. Aspiration pneumonia and chemical pneumonitis are often considered together because they both involve lung inflammation caused by inhaling substances that irritate the lungs. Complications may occur, such as exudative pleural effusion, empyema, and lung abscesses. [21] For people who are critically ill that require a feeding tube, there is evidence suggesting that the risk of aspiration pneumonia may be reduced by inserting the feeding tube into the duodenum or the jejunum (post-pyloric feeding), when compared to inserting the feeding tube into the stomach (gastric feeding). [23] Identifying these conditions before the operation begins is essential for proper preparation during the procedure. [12], Dysphagia clinicians often recommend alteration of dietary regimens, altered head positioning, or removal of all oral intake. Aspiration is when something enters your airway or lungs by accident. Whether your immune system is weakened Risk factors for breathing in (aspiration) of foreign material into the lungs are: 1. Other risk factors for aspiration pneumonia include: esophageal disorders or dysfunction. Tests may include: Aspiration is when something enters your airway or lungs by accident. ", "Comorbid disease and the effect of race and ethnicity on in-hospital mortality from aspiration pneumonia", "Post-pyloric versus gastric tube feeding for preventing pneumonia and improving nutritional outcomes in critically ill adults", "Pneumonitis and pneumonia after aspiration", "Aspiration Pneumonitis and Pneumonia: Overview of Aspiration Pneumonia, Predisposing Conditions for Aspiration Pneumonia, Pathophysiology of Aspiration Pneumonia", "Evaluation of the Natural History of Patients Who Aspirate", "Characteristics associated with clinician diagnosis of aspiration pneumonia; a descriptive study of afflicted patients and their outcomes", "Acute Intraoperative Pulmonary Aspiration", "Prognostic implications of aspiration pneumonia in patients with community acquired pneumonia: A systematic review with meta-analysis", "An Acute Model of Care to Guide Eating & Drinking Decisions in the Frail Elderly with Dementia and Dysphagia", "The effect of a daily application of a 0.05% chlorhexidine oral rinse solution on the incidence of aspiration pneumonia in nursing home residents: a multicenter study", "Age-Related Changes to Eating and Swallowing Impact Frailty: Aspiration, Choking Risk, Modified Food Texture and Autonomy of Choice", "Management of Dysphagia in Patients with Parkinson's Disease and Related Disorders", Combined pulmonary fibrosis and emphysema, Bronchiolitis obliterans organizing pneumonia, https://en.wikipedia.org/w/index.php?title=Aspiration_pneumonia&oldid=998383887, Articles with unsourced statements from September 2020, Wikipedia medicine articles ready to translate, Creative Commons Attribution-ShareAlike License, Microscopic image of aspiration pneumonia in an elderly person with a neurologic illness. [18] Clinical symptoms may also increase suspicion of aspiration pneumonia, including new difficulty breathing and fever after an aspiration event. Your recent antibiotic use 5. COVID-19 pneumonia, however, is not bacterial, but viral. [23] The administration of anesthesia causes suppression of protective reflexes, most importantly the gag reflex. [5], Aspiration pneumonia is often caused by a defective swallowing mechanism, such as a neurological disease or as the result of an injury that directly impairs swallowing or interferes with consciousness. Yoneyama T, et al. [10] Common aerobic bacteria involved include: Anaerobic bacteria also play a key role in the pathogenesis of aspiration pneumonia. Whether you were recently hospitalized 4. [12] Potential anaerobic bacteria are as follows: Aspiration is defined as inhalation of oropharyngeal or gastric contents into the pulmonary tree. [2] Risk factors include decreased level of consciousness, problems with swallowing, alcoholism, tube feeding, and poor oral health. These bacteria may go on and infect the lungs because of the weakened immune system. It is similar to the pneumonias that accompanied Severe Acute Respiratory Syndrome (SARS) in 2003 and severe cases of the H1N1 … In the elderly, dysphagia is a significant risk factor for the development of aspiration pneumonia. blood culture. Breathing that speeds up or stops while feeding. [1] It occurs more often in older people, especially those in nursing homes. There are also many contributory factors such as poor oral hygiene, high dependency levels for being positioned and fed, as well as the need for oral suctioning. Pneumonia is a breathing condition in which there is inflammation (swelling) or an infection of the lungs or large airways. Aspiration pneumonia most often develops due to micro-aspiration of saliva, or bacteria carried on food and liquids, in combination with impaired host immune function. [17] For example, people that are supine when they aspirate often develop consolidation in the right lower lobe of the lung. [1] Some include chemical induced inflammation of the lungs as a subtype, which occurs from acidic but non-infectious stomach contents entering the lungs. For individuals older than 75, the risk of pneumonia due to dysphagia, is six times greater than those 65. [16] Findings on chest x-ray supportive of aspiration pneumonia include localized consolidation depending on the patient's position when the aspiration occurred. [4] Another possible complication is an empyema, in which pus collects inside the lungs. Aspiration pneumonia is caused by bacteria that normally reside in the oral and nasal pharynx. [25], Aging increases the risk of dysphagia. [1] Diagnosis is typically based on the presenting history, symptoms, chest X-ray, and sputum culture. Aspiration pneumonia is a form of pneumonia that may occur when a person breathes something in, rather than swallowing it. The third complication occurs after inhalation of particulate matter that obstructs airways. [24] If there is a large accumulation of fluid within the lungs, drainage of the fluid may also aid in the healing process. [20] The use of antimicrobials is reserved for chemical pneumonitis complicated by secondary bacterial infection.[18]. Chemical pneumonitis may develop whose severity depends on the pH value and quantity of aspirate. [27] Atypical presentation is common in the elderly. References. Northwestern Medicine® is a trademark of Northwestern Memorial HealthCare, used by Northwestern University. bronchoscopy. [1] Broad antibiotic coverage is required to account for the diverse types of bacteria possibly causing the infection. The reported prevalence of dysphagia in patients with Parkinson's disease ranges from 20% to 100% due to variations in the methods of assessing the swallowing function. The possibility of bacteria to cause aspiration pneumonia, depends on: 1… A patient's individual vigor may impact the development of pulmonary infections more than aspiration. [1][2], Infection can be due to a variety of bacteria. The term aspiration pneumonia is usually reserved for a lung infection, mainly bacterial, where the bacteria carried into the lung is through aspirated material. Most episodes cause transient symptoms of pneumonitis(inflammation of the air sacs of the lung) without infection or obstruction. Inflammation is the body's immune response to any perceived threat to the body. The ability of clinical interventions to reduce pneumonia incidence is relatively unknown. Aspiration can cause pneumonia, or lung infection which causes shortness of breath, and lead to other … Bacterial colonization: Poor oral hygiene can result in colonization of the mouth with excessive amounts of bacteria, which is linked to increased incidence of aspiration pneumonia. People who aspirate while standing can have bilateral lower lung lobe infiltrates. Aspiration increases your risk for aspiration pneumonia. ASPIRATION Aspiration occurs when food or saliva enters the airway and lungs. 1. stroke. [3] If left untreated, aspiration pneumonia can progress to form a lung abscess. [14], Studies have shown that aspiration pneumonia has been associated with an overall increased in-hospital mortality as compared with other forms of pneumonia. Acid reflux is a known cause of frequent regurgitation. Possible causative agents include radiation therapy of the chest, exposure to medications used during chemo-therapy, the inhalation of debris (e.g., animal dander), aspiration… chest X-ray. [1] Complications may include lung abscess. Northwestern Medicine offers a wide range of classes, events and support groups throughout the year – in your local community – to help you live a healthier, happier and more informed life. [21] One broad method of decreasing the number of bacteria in the mouth involves the use of antimicrobials, ranging from topical antibiotics to intravenous antibiotic use. It is most serious for infants and young children, people older than age 65, … [26], chemical induced inflammation of the lungs, "Preventing aspiration pneumonia in older people: do we have the 'know-how'? Aspiration pneumonia is a type of lung infection that is due to a relatively large amount of material from the stomach or mouth entering the lungs. Aspiration pneumonia can occur to anyone, but it is most common among people with dysphagia, a swallowing disorder caused by abnormally functioning muscles in the throat and esophagus. Drowning may also cause … After falls, choking on food presents as the second highest cause of preventable death in aged care. A variety of organisms, including bacteria, viruses and fungi, can cause pneumonia.Pneumonia can range in seriousness from mild to life-threatening. A subtype of aspiration pneumonia, known as chemical pneumonia, involves the introducti… [12] They make up the majority of normal oral flora and the presence of putrid fluid in the lungs is highly suggestive of aspiration pneumonia secondary to an anaerobic organism. Note, ~10% of pneumonia cases requiring hospitalization, Impaired swallowing: Conditions that cause. The type of bacteria that caused the pneumonia depends on: 1. While tube feeding might therefore be considered a safer option, tube feeding has not been shown to be beneficial in people with advanced dementia. [5] Some cases of aspiration pneumonia are caused by aspiration of food particles or other particulate substances like pill fragments; these can be diagnosed by pathologists on lung biopsy specimens. This can cause serious health problems, such as pneumonia. Signs and symptoms often include fever and cough of relatively rapid onset. The preferred option therefore is to continue eating and drinking orally despite the risk of developing chest infections. RDH. When you eat, muscles push food and liquids from your throat through your esophagus, the muscular tube connecting the mouth to … Causes and Diagnoses Causes and Diagnoses of Aspiration Pneumonia. [28] Pneumonitis describes general inflammation of lung tissue. Generally, the right middle and lower lung lobes are the most common sites affected, due to the larger caliber and more vertical orientation of the right mainstem bronchus. [15], Aspiration pneumonia is typically diagnosed by a combination of clinical circumstances (people with risk factors for aspiration) and radiologic findings (an infiltrate in the proper location). The patients will have sudden arterial hypoxemia with development of lung atelectasis. heart attack. These conditions enable the entry of bacteria into the lungs, thus allowing the development of an infection. [1] Treatment with piperacillin/tazobactam, cefepime, levofloxacin, imipenem, or meropenem is recommended in cases of potential antibiotic resistance. [23] Other practices that may be beneficial but have not been well-studied include medication that reduce the acidity of gastric contents and rapid sequence induction. Oxygen-free radicals are generated which, in turn, lead to further lung damage. Complications may include lung abscess. The aspiration (drawing in) of these substances can cause inflammation, infection, or airway obstruction. [19], While aspiration pneumonia and chemical pneumonitis may appear similar, it is important to differentiate between the two due to major differences in management of these conditions. © 2021 by Northwestern Medicine® and Northwestern Memorial HealthCare. Where you live (at home or in a long-term nursing facility, for example) 3. In fact, these individuals were also found to be at higher risk for readmission after being discharged from the hospital. [1][2] Differentiating from other types of pneumonia may be difficult. [23] On the other hand, regarding reducing acidity of the stomach, an acid environment is needed to kill the organisms that colonize the gastrointestinal tract; agents, such as proton pump inhibitors, that decrease the acidity of the stomach, may favor the growth of bacteria and increase the risk of pneumonia. 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