Aspiration Pneumonitis
A chemical injury caused by the inhalation of gastric contents
Abrupt onset/resolution
Fever resolves in 24-48 hours
Hypoxemia resolves in 24-48 hours
Aspiration Pneumonia
An infectious process caused by the inhalation of oropharyngeal secretions that are colonized by pathogenic bacteria
Slow onset/not acute
Fever not resolving
Hypoxemia ongoing
Most people with aspiration do not develop pneumonia and can be managed with the wait and watch approach
Fever, crackles, and new chest radiograph (CXR) opacification can be seen in both aspiration pneumonitis and pneumonia
Wait and Watch Approach
If patient is stable, monitor for signs and symptoms for 48 hours; antibiotics are not required
Antibiotic Treatment
Antibiotic treatment of patients who develop fever, leukocytosis and infiltrates in the first 48 hours after an aspiration event is likely unnecessary and may only select for resistant organisms
Empiric Treatment