Management of Aspiration Pneumonitis

Initial Assessment and Differentiation

Clinical signs suggesting bacterial pneumonia include fever, productive cough, leukocytosis, and failure to improve with supportive care alone, as indicated by the American College of Physicians, 1

Maintain semi-recumbent positioning (45° head elevation) to prevent further aspiration, as recommended by the American Thoracic Society, 2
Provide supplemental oxygen to maintain adequate saturation, according to the American Thoracic Society, 3
Consider noninvasive positive-pressure ventilation before intubation when appropriate, as suggested by the American Thoracic Society, 2

Obtain initial chest radiograph (posteroanterior and lateral if possible) to establish baseline, as recommended by the American College of Radiology, 3
Do not routinely repeat chest X-rays unless clinical deterioration occurs, according to the American College of Radiology, 1

Reassess patients who fail to improve after 48-72 hours of appropriate therapy, as recommended by the Infectious Diseases Society of America, 4
Evaluate for complications: empyema, lung abscess, ARDS, or extrapulmonary infection, as suggested by the American Thoracic Society, 3

Maintain semi-recumbent positioning during feeding and for at least 30 minutes after, as recommended by the American Gastroenterological Association, 2
Use oral (not nasal) endotracheal and gastric tubes when possible, according to the American Thoracic Society, 2
Minimize sedation and facilitate early extubation, as suggested by the American Thoracic Society, 2
Consider continuous subglottic suctioning in intubated patients, as recommended by the American Thoracic Society, 2