Aspiration Diagnosis and Management

Clinical Presentation

The American Thoracic Society recommends that cough is considered the hallmark clinical sign of aspiration, and should prompt immediate evaluation for dysphagia and aspiration risk 1
Wheeze is commonly present with aspiration events, as indicated by the American Journal of Respiratory and Critical Care Medicine 2
Stridor indicates upper airway involvement, according to the American Journal of Respiratory and Critical Care Medicine 2
Wet or gurgly voice quality after swallowing is a sign of pooled secretions, as noted by the American College of Chest Physicians 1
Increased respiratory secretions with tachypnea are associated with aspiration, as reported by the American Journal of Respiratory and Critical Care Medicine 2

Patients with unexplained cough and reduced level of consciousness should be referred for oral-pharyngeal swallow evaluation, ideally to a speech-language pathologist, as recommended by the American College of Chest Physicians 1
Neurologic conditions, such as stroke, increase the risk of aspiration, with 84% of aspirators having weak or absent voluntary cough, according to the American College of Chest Physicians 1
Post-prematurity respiratory disease with persistent oxygen desaturation during feeding is a high-risk condition for aspiration, as indicated by the American Journal of Respiratory and Critical Care Medicine 2
Suspected or confirmed vocal cord paralysis or other airway anomalies increase the risk of aspiration, as reported by the American Journal of Respiratory and Critical Care Medicine 2

Videofluoroscopic swallow study (VFSS) is the gold standard for diagnosis of aspiration, as recommended by the American Journal of Respiratory and Critical Care Medicine 2
VFSS is recommended for infants, children, and adolescents with post-prematurity respiratory disease who are eating by mouth and have cough or persistent oxygen desaturation during feeding, according to the American Journal of Respiratory and Critical Care Medicine 2

The American College of Chest Physicians recommends that patients with clinical signs of aspiration during feeding should stop oral feeding immediately and maintain airway patency, with supplemental oxygen if needed 1, 2
Broad-spectrum antibiotics covering oral flora and anaerobes are required for aspiration pneumonia, as reported by Thorax 3
Management of underlying dysphagia is essential to prevent recurrence of aspiration pneumonia, as noted by the American College of Chest Physicians 1

Thickened feeds for patients with documented aspiration on VFSS can help prevent aspiration, as recommended by the American Journal of Respiratory and Critical Care Medicine 2
Positioning modifications during feeding and swallowing therapy with a speech-language pathologist can help prevent aspiration, according to the American College of Chest Physicians 1
Patients with reduced consciousness should not be fed orally, as recommended by the American College of Chest Physicians 1