Aspiration Pneumonia

A 72-year-old nursing home resident was hospitalized with fever, chills, and rigors of 2 days' duration. The nursing home staff reported the patient had dysphagia after a recent stroke.

A chest film taken on admission showed a definite alveolar infiltrate in the right upper lobe region-evidence of pulmonary aspiration pneumonia. Drs Mahesh Duggal, Samit Hirawat, and Arunabh of Queens, NY, comment that risk factors for pulmonary aspiration include uncontrolled seizures, stroke, drug intoxication, esophageal dysmotility, and prolonged use of a nasogastric tube.

Persons at risk for pulmonary aspiration are those with impaired consciousness or altered respiratory tract anatomy. In these persons, aspiration generally involves a dependent region of the lung; in a supine patient, the superior segment of the lower lobe or the posterior segment of the upper lobe is usually involved. The right side of the lung more commonly is affected.

The three types of aspiration pneumonia are based on the nature of the aspirated material. Aspiration of gastric juice causes chemical pneumonitis, airway obstruction from food particles leads to atelectasis and pneumonia, and aspiration of infectious organisms from the mouth causes bacterial pneumonia. When broad-spectrum antibiotic therapy fails to cure bacterial pneumonia, suspect ongoing airway obstruction or lung abscess.

Prevention is key to reducing morbidity and mortality from aspiration pneumonia in the high-risk population. Among the techniques that may be helpful are elevation of the patient's head, control of seizures, and use of percutaneous gastric tube feeding.

This patient was treated with broad-spectrum antibiotics; the recovery was uneventful.