Aspiration Pneumonia

Definition:

Aspiration pneumonia is inflammation of the lungs and airways to the lungs (bronchial tubes)
from breathing in foreign material.

Causative Agent:

1) Breathing in foreign materials (usually food, liquids, vomit, or fluids from the mouth) into the
lungs

* Aspiration of foreign material into the lungs can be caused by:

• Anesthesia
• Coma
• Decreased or absent gag reflex in people who are not alert (unconscious or semi-
conscious)
• Dental problems
• Disorders that affect normal swallowing
• Disorders of the esophagus (esophageal stricture, gastroesophageal reflux)
• Excessive alcohol use
• Medications that affect alertness
• Old age
• Sedatives

Signs and Symptoms:

1) Bluish discoloration of the skin caused by lack of oxygen

2) Chest pain
3) Cough
- With foul-smelling phlegm (sputum)
- With sputum containing pus or blood
- With greenish sputum
4) Fatigue
5) Fever
6) Shortness of breath
7) Wheezing
8) Breath odor
9) Excessive sweating
10) Swallowing difficulty

* A physical examination may reveal crackling sounds in the lungs and a rapid pulse (heart
rate).

The following tests may also help diagnose this condition:

• Arterial blood gas
• Blood culture
• Bronchoscopy
 • Chest x-ray
• Complete blood count (CBC)
• CT scan of the chest
• Sputum culture
• Swallowing studies

* Signs of tachypnea, cough, rales, cyanosis, wheezing, fever, leukocytosis and, occasionally,
apnea develop, usually, within two hours of the aspiration.

Pathophysiology:

Aspiration is the introduction of a foreign substance into the lungs, but the mere instillation of
foreign substance into the subglottic airway is not sufficient to produce disease. Damage to the
pulmonary tree, which ranges from mild to fatal, depends on the nature, volume and pH of the
aspirated contents, and the pathogenicity of the organisms. Physiologic changes resulting from
aspiration of acidic fluid or gastric contents include a decline in arterial blood oxygen tension,
increased alveolar capillary membrane permeability, and a decrease in intravascular volume.
The lungs can become edematous and gas exchange abnormalities are the result. Histologic
examination shows tracheal mucosal desquamation, damage to the cells of the alveolar lining
and capillary inflammation 24 to 36 hours after aspiration.

Nursing Mangements:

1) Put the Patient in an Upright Position.

- To avoid incurring risk of aspiration, the critical care nurse puts the patient in an upright
position. Many authors believe the head of the bed elevated to an angle between 30 to
45 degrees will help prevent aspiration because the effect of gravity will decrease
gastroesophageal reflux and as such, the risk of aspiration.

2) Encourage to avoid excessive alcohol use.

3) Instruct to change position at least every two hours when recumbent.

4) Encourage to feed the patient in small amounts.

5) Provide oral care before and after meals and more frequently if needed.

6) Allow a 30-minute rest period before meals.

7) Evaluate Use of Continuous vs Intermittent Feedings.

- Continue to evaluate the merits of continuous or intermittent feedings because it is
unclear which method is better. Proponents of the continuous infusion method argue that
gradual delivery of small amounts prevent distention and, therefore, decrease the
occurrence of gastroesophageal reflux. Proponents of the intermittent administration say
that it is a more physiologically normal feeding method and decreases the risk of
aspiration by decreasing the amount of time that the enteral formula is in the stomach.

8) Assess Outcomes from Gastric vs Intestinal Tubes.

 - Observe outcome differences between nasointestinal versus nasogastric tubes
because research does not clearly describe the risks of each yet. Many clinicians favor
the use of nasointestinal tubes (NIT) over NGT in decreasing the risk of
gastroesophageal reflux (GER). Cogen et al., state that although it is believed that small
bowel tube feeding decreases the risk of aspiration, this has not been confirmed.

9) Detect Aspiration of Gastric Contents into the Pulmonary Bed.

- The nurse helps assess if the aspiration is from gastric juices. Several methods for
detection of aspiration of gastric contents into the pulmonary bed have been identified.
Food coloring is widely used for the early detection of aspiration. Generally, green or
blue color added to tube feeding solution provides visual confirmation of aspiration.

10) Monitor Airway Cuff Pressure.

- Critical care nurses carefully monitor the cuff pressure in airways to prevent aspiration
around the cuff. Inflation of the cuff for artificial airways helps but does not eliminate the
risk for aspiration of oral secretions into the lower airways.