Aspiration Pneumonia

Risk Factors for Aspiration

  • Debilitation
  • History of Dysphagia
  • Intubation: of any duration
    • Swallowing difficulties exist in 50% of intubated patients for up to 1 week after
    • No clinical factors reliably predict if patient will aspirate
  • Muscle Weakness
  • Older Age
  • Oral/Nasal Enteral Feeding Tubes
  • Tracheostomy (see Tracheostomy, [[Tracheostomy]])


Upper Airway Structural/Functional

  • Bilateral Vocal Fold Immobility (BVFI) (see Bilateral Vocal Fold Immobility, [[Bilateral Vocal Fold Immobility]]): of any etiology
  • Cervical Spine Surgery





  • Assessment of Swallowing Function
    • Bedside Swallowing Evaluation: relatively insensitive for evidence of aspiration in patients with tracheostomy, since up to 77% of aspiration was silent [MEDLINE] [MEDLINE]
    • Gag Reflex: does not predict adequacy of swallowing function (as gag reflex uses different muscles than swallowing and many patients without gag can swallow normally)
    • Modified Barium Swallow: best test
  • Sputum Gram Stain/Culture and Sensitivity
  • CXR/Chest CT Patterns
    • Alveolar Infiltrate: often located in dependent lung region (particularly RLL-superior segment)
    • Bibasilar Fibrosis: may be seen in cases of chronic aspiration

Clinical Presentations


Measures To Decrease Risk of Aspiration

  • NPO
  • Nasogastric Feeding
  • Gastrostomy Tube Placement
  • Cuffed Tracheostomy
  • Laryngeal-Tracheal Separation/Laryngectomy: last resort treatment
    • Allows PO intake, but speaking is not possible
    • Proven effective and beneficial to improve mood and clinical outcome

Treatment of Aspiration Pneumonia

  • Antibiotics (per Infectious Disease Society of America/ISDA Recommendations): second agent for anaerobic coverage may be unnecessary, as Gatifloxacin/Moxifloxacin have adequate anaerobic coverage
    • Newer Generation Fluoroquinolone (Levofloxacin/Gatifloxacin/Moxifloxacin) (see Fluoroquinolones, [[Fluoroquinolones]]) + Piperacillin/Tazobactam (Zosyn) (see Piperacillin-Tazobactam, [[Piperacillin-Tazobactam]])
    • Newer Generation Fluoroquinolone (Levofloxacin/Gatifloxacin/Moxifloxacin) (see Fluoroquinolones, [[Fluoroquinolones]]) + Ampicillin/Sulbactam (Unasyn) (see Ampicillin-Sulbactam, [[Ampicillin-Sulbactam]])
    • Newer Generation Fluoroquinolone (Levofloxacin/Gatifloxacin/Moxifloxacin) (see Fluoroquinolones, [[Fluoroquinolones]]) + Metronidazole (Flagyl) (see Metronidazole, [[Metronidazole]])
    • Newer Generation Fluoroquinolone (Levofloxacin/Gatifloxacin/Moxifloxacin) (see Fluoroquinolones, [[Fluoroquinolones]]) + Clindamycin (see Clindamycin, [[Clindamycin]])


  • Pulmonary aspiration in mechanically ventilated patients with tracheostomies. Chest. 1994 Feb;105(2):563-6 [MEDLINE]
  • Swallowing dysfunction in patients receiving prolonged mechanical ventilation. Chest. 1996 Jan;109(1):167-72 [MEDLINE]
  • Satisfaction of patients treated surgically for intractable aspiration. Chest. 1999 Nov;116(5):1251-6 [MEDLINE]