Ruqayyah Snyder
Aspiration pneumonia is a bacterial infection in the lungs caused by inhaling something other than air, such as food, liquid, saliva, or stomach contents. It is a frequent cause of death in surgical patients, and people with intellectual and developmental disabilities (IDD). In Australia, a 10-year review from 2008 to 2017 found that there were 1103 aspiration pneumonia-related deaths, accounting for an average of 5.2% of all notified surgical deaths. This article will explore the incidence, risk factors, prevention, and treatment of aspiration pneumonia in Australia, providing insights into this potentially life-threatening condition.
| Characteristics | Values |
|---|---|
| Number of deaths in Australia over a 10-year period | 1103 |
| Percentage of all surgical deaths in Australia over a 10-year period | 5.2% |
| Average number of deaths per year in Australia | 110.3 |
| Main factor in death | 53.5% |
| Contributory factor | 46.5% |
| Cause of aspiration pneumonia | Inhaling food, liquid, saliva, or stomach contents |
| Treatment | Antibiotics, oxygen therapy, mechanical ventilation |
| Risk factors | Swallowing disorders, poor trunk control, scoliosis, enteral nutrition via gastrostomy, jejunostomy, or nasogastric tubes |
| Prevention | Optimal body positioning during and after eating, speech-language pathology, dietetics, oral hygiene, nutrition |
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What You'll Learn
Surgical deaths related to aspiration pneumonia
Aspiration pneumonia is an infection caused by inhaling something other than air into the lungs. This could be food, liquid, saliva, or stomach contents. Many people are unaware that they have aspirated something. Symptoms include fever, shortness of breath, coughing up blood or pus, chest pain, and tiredness. It is usually treated with antibiotics, and in severe cases, oxygen therapy or mechanical ventilation may be required.
Acute respiratory problems are a common cause of death in surgical patients, and aspiration pneumonia (AP) is a significant contributor. A 10-year review of surgical deaths in Australia from 2008 to 2017 found that AP-related deaths accounted for 1103 cases, or 5.2% of all notified surgical deaths. In 53.5% of these cases, AP was the primary cause of death, while it was a contributing factor in 46.5% of the cases. The majority of patients were male (61.4%), aged 70 or older (84.6%), and had an ASA score of 3 or higher (85%). Most AP-related deaths occurred during emergency admissions (85%). Surgery was performed within 30 days of death in 84% of cases, with general and orthopedic surgeries being the most common.
Risk factors for fatal outcomes in surgical patients with postoperative aspiration pneumonia include increasing age, the need for intraoperative blood transfusions, and bilateral pulmonary infiltrates. These patients require enhanced monitoring and attention. Additionally, pre-, intra-, and postoperative risk factors can influence mortality rates, which have been observed to be around 30% in patients with clinically and radiologically confirmed aspiration pneumonia after abdominal surgery.
Aspiration pneumonia is a preventable condition, and improved recognition of risk factors can help reduce the risk of surgical deaths associated with it. Further research and understanding of patient factors associated with mortality can aid in developing strategies to mitigate this devastating outcome.
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Causes of aspiration pneumonia
Aspiration pneumonia is an infection caused by inhaling something other than air into the lungs. This could be food, liquid, saliva, or stomach contents. When food or liquid goes down the windpipe towards the lungs instead of the oesophagus (towards the stomach), it is known as "going down the wrong pipe". In such cases, the body reacts by coughing it out. However, some people are unable to do so, and the foreign substance ends up in their lungs. This can cause bacteria to grow and lead to an infection.
Many people with aspiration pneumonia are unaware that they have inhaled a foreign substance, a condition called silent aspiration. The infection can develop days or even weeks after the inhalation. While the bacterial load in microaspirations may be minimal, recurrent microaspirations can progressively lead to recurrent aspiration pneumonia over time due to repetitive epithelial injury. The mucociliary transport mechanism and the macrophage-dependent clearance of aspirated material may become compromised. In individuals with compromised immunity, subsequent exposure to aspirated organisms in the alveolar space can cause infection. Various interacting mechanisms can contribute to impaired swallowing.
Aspiration pneumonia is most common among people with dysphagia, a swallowing disorder caused by abnormally functioning muscles in the throat and oesophagus. It is characterised by symptoms such as coughing, fever, shortness of breath, chest pain, and tiredness. Treatment for aspiration pneumonia typically involves antibiotics, and in severe cases, oxygen therapy or mechanical ventilation may be required.
The management of aspiration pneumonia has evolved over time. Anaerobic coverage is no longer recommended in the empirical treatment of aspiration pneumonia due to the low frequency of actual anaerobic infections causing it. The Infectious Diseases Society of America (IDSA) suggests anaerobic coverage only in cases of "classic aspiration pleuropulmonary syndromes", where patients have a history of loss of consciousness and concomitant gingival disease or oesophageal motility disorders.
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Aspiration pneumonia treatment
Aspiration pneumonia is a bacterial infection in the lungs caused by inhaling something other than air, such as food, liquid, saliva, stomach contents, or toxic and/or irritant substances. It is a common complication of multiple sclerosis, motor neuron diseases, Huntington's disease, Down syndrome, and cerebral palsy. Head and neck cancer and its treatment also increase the risk of developing aspiration pneumonia.
In Australia, aspiration pneumonia is a frequent cause of death in surgical patients, with a 10-year review from 2008 to 2017 finding that there were 1103 aspiration pneumonia-related deaths, averaging 5.2% of all notified surgical deaths.
The treatment for aspiration pneumonia typically involves the use of antibiotics to address the bacterial infection. The severity of the symptoms will determine if additional treatments, such as oxygen therapy or mechanical ventilation, are necessary.
The initial step in determining a treatment plan is to assess the severity of the pneumonia. This involves evaluating factors such as respiratory rate and white blood cell count.
For aspiration pneumonitis, which is caused by inhaling toxic substances, the treatment is primarily supportive, often involving supplemental oxygen and mechanical ventilation. Antibiotics are typically reserved for patients with witnessed or known gastric aspiration, and they can be discontinued if patients show rapid improvement.
It is important to note that the recommendations for managing aspiration pneumonia have evolved, and clinicians must stay updated to ensure accurate diagnosis and effective treatment.
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Risk factors for aspiration pneumonia
Aspiration pneumonia predominantly affects older adults, especially those with advanced age, poor mobility, frailty, and underlying comorbidities. It is a leading cause of death among ageing populations. Individuals with learning disabilities or gastrointestinal and neurologic disorders that disrupt normal swallowing function are also at heightened risk.
Several factors contribute to the risk of developing aspiration pneumonia. Poor oral health, including poor oral hygiene, has been established as a significant risk factor. This is because aspiration pneumonia is triggered by the inhalation of bacteria-rich oropharyngeal fluids into the lower respiratory tract, and poor oral health increases the degree of bacterial colonisation in oral secretions.
Other risk factors include:
- Dependence on feeding support or oral care
- Limited or infrequent ambulation
- Compromised respiratory system
- Impaired cough function
- Previous aspiration pneumonia
- Impaired health status (including a compromised immune system)
- Gastrointestinal disease
- Smoking
- Malnutrition
- Dry mouth
- Sputum suctioning
- Daily oxygen therapy
- Urinary catheterisation
- Deterioration of swallowing function
- Dehydration
- Dementia
Gastrointestinal and neurological disorders can also increase the risk of aspiration pneumonia by disrupting normal swallowing function.
It is important to note that healthy people do not develop aspiration pneumonia, so understanding how the body responds to stress and illness is crucial. Additionally, certain medical procedures, such as head and neck cancer treatment, can increase the risk of developing aspiration pneumonia.
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Preventing aspiration pneumonia
Aspiration pneumonia is a bacterial infection in the lungs caused by inhaling something other than air, such as food, liquid, saliva, or stomach contents. This condition can be challenging to identify, as many people do not realise they have aspirated something. It often affects older individuals and can lead to hospitalisation and even death. While the exact incidence of aspiration pneumonia-related deaths in Australia is unclear, a 10-year review from 2008 to 2017 found that out of 21,038 surgical deaths, 1103 were related to aspiration pneumonia, contributing to 5.2% of all notified surgical deaths.
To prevent aspiration pneumonia, particularly in older adults, here are several strategies that can be implemented:
Maintain Good Oral Hygiene
Good oral hygiene is crucial in preventing aspiration pneumonia. Proper oral care can reduce the risk of bacteria buildup and subsequent infection in the lungs. This includes regular brushing and flossing, as well as maintaining overall oral health.
Avoid Medications Affecting Salivary Flow or Causing Sedation
Medications that affect salivary flow or cause sedation can increase the risk of aspiration. It is important to be cautious when taking such medications and consult with a healthcare professional about alternative options if necessary.
Minimise the Use of H2 Blockers and Proton-Pump Inhibitors (PPIs)
H2 blockers and PPIs can reduce acid secretion, which may increase the risk of aspiration pneumonia. It is recommended to minimise the use of these medications unless they are specifically required for another medical condition.
Consider Alternative Feeding Methods
Tube feeding, such as nasogastric or gastrostomy tubes, has been controversial in preventing aspiration pneumonia. Evidence suggests that tube feeding may not effectively prevent aspiration pneumonia and could even increase the risk. Assisted hand feeding is often a preferable alternative, as it allows for better control and a reduced risk of aspiration.
Address Folate Deficiency
Folate deficiency has been linked to an increased risk of aspiration pneumonia in older patients. Prompt correction of this deficiency through dietary changes or supplements can help reduce the likelihood of developing aspiration pneumonia.
Create a Calm and Distraction-Free Eating Environment
A calm and distraction-free environment during mealtimes can help older individuals focus on eating and reduce the risk of aspiration. Loud noises, conversations, or distractions from television can hinder their ability to complete their meals, potentially impacting their health.
Treat Underlying Medical Conditions
Certain underlying medical conditions can increase the risk of aspiration pneumonia. Working closely with a healthcare provider to manage these conditions is essential for preventing aspiration pneumonia and improving overall health outcomes.
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Frequently asked questions
Aspiration pneumonia is an infection caused by inhaling something other than air into your lungs. This could be food, liquid, saliva, vomit, or stomach contents.
Symptoms include fever, shortness of breath, coughing up blood or pus, chest pain, and tiredness.
Providers typically treat aspiration pneumonia with antibiotics. Depending on the severity of symptoms, oxygen therapy or mechanical ventilation may also be required.
While there is limited data on the exact number of deaths attributed to aspiration pneumonia in Australia, a 10-year review from 2008 to 2017 found that there were 1103 aspiration pneumonia-related deaths in New South Wales, accounting for an average of 5.2% of all notified surgical deaths during that period.
