Aspiration Chemical Pneumonitis a k a Aspiration Lung

Aspiration (“Chemical”) Pneumonitis (a. k. a. Aspiration Lung Injury) • Entry of aspirate from oropharynx -> larynx and lower respiratory tract • Causes chemical injury to lungs • May initially be sterile – Can get subsequent secondary bacterial infection Clinical Features: • • • Non-Productive Cough Tachypnoea Bronchospasm Bloody/Frothy Sputum Respiratory Distress 2 -5 hours after aspiration M Patel, SHO, QAH ED

Aspiration (“Chemical”) Pneumonitis Reduced Consciousness Seizure, Trauma, GA, Drug Overdose Other Neurological Problems CVA, MS, PD Dysphagia Oseophageal Ca, Stricture, Fistula, Reflux , Dysmotiliy Aspiration Risk Factors Vomiting, positioning, pharyngeal anaesthesia Mechanical Disruption/Instrumentation NG Tube, Intubation, Endo/bronchoscopy, M Patel, SHO, QAH ED

Aspiration (“Chemical”) Pneumonitis CXR Findings • Dependent (Patchy) Lung Infiltrate Upright Aspiration Basal Segments Lower Lungs Supine Aspiration Post Upper Lobes / Apical Lower Lobes M Patel, SHO, QAH ED

Aspiration (“Chemical”) Pneumonitis Initial Management Pointers • A – Suction Visible Oral Cavity (If ongoing/witnessed) – Protect / Prevent Further • (NG/Left Lateral Positioning/Definitive Airway Protection) – Oxygen • B – Nebs • Abx if – Signs of infection – Not improving – High risk for bacterial containing aspirate M Patel, SHO, QAH ED