Aspiration of low pH gastric fluid or food matter is common in critically ill patients and often underdiagnosed.
Patients with aspiration initially develop a pneumonitis that, in some, can be complicated by bacterial pneumonia. Up to 33% develop severe ALI/ARDS, with an associated 30% mortality rate.
Aspiration pneumonitis presents with hypoxia and a CXR demonstrating infiltrates in the dependent portion of the lungs. Often, the degree of respiratory distress is worse than the CXR appearance.
Since it is challenging to differentiate aspiration pneumonia from aspiration pneumonitis, current recommendations suggest initiating empiric antibiotics with agents that have adequate Gram-negative coverage. Routine coverage against anaerobic bacteria is not currently recommended, except in patients with severe periodontal disease and those with a lung abscess on CXR or CT.
Despite the initial inflammatory response, steroids are not indicated for patients with aspiration.
References
Ragavendran K, Nemzek J, Napolitano LM, Knight PR. Aspiration-induced lung injury. Crit Care Med 2011; 39:818-26.
