Aspiration Pneumonia & Respiratory System Overview

Aspiration Pneumonia & Oral Infection Control

• Aspiration pneumonia is the entry of food, liquid, saliva, nasal secretions, or gastric content into the airway below the vocal folds.
• This can occur before, during, or after swallowing and can be overt (with signs) or silent (no signs).
• Overt signs of aspiration include cough, wheeze, stridor, frequent throat clearing, gagging, nasal regurgitation, multiple swallows, desaturation/apnea during feeding, wet/gurgly voice, and labored breathing.
• Aspiration can lead to respiratory disease, severe lung damage, and death.

Respiratory System Structures

• Includes upper and lower respiratory tracts.
• Upper respiratory tract consists of nasal cavity, pharynx, and larynx.
• Lower respiratory tract consists of trachea, bronchi, bronchioles, and alveoli.
• Anatomical diagrams of the respiratory system are included showing the structures.

What is Pneumonia?

• Pneumonia is an acute infection of lung tissue.
• Types of pneumonia include aspiration pneumonia, community-acquired, hospital-acquired, pneumonitis, and ventilator-associated.

The Lung Microbiome in Pneumonia

• Lung microbiome stability depends on a balance between immigration (bacteria from the oropharynx) and elimination (through cough and cilia).
• Inflammatory events can disrupt homeostasis, increasing infection risk.

Bacteria Colonization Sites

• Bacteria can colonize various oral cavity sites, including gingiva, dental plaque, and tongue.
• Certain gram-negative species, usually not found in healthy individuals, can be found in individuals in nursing homes, elderly individuals, patients with nasogastric/gastric tubes, or those with acute illnesses.

Aspiration Pneumonia vs. Aspiration Pneumonitis

• Aspiration pneumonia is an infection caused by specific oral microorganisms.
• Aspiration pneumonitis is a non-infectious inflammatory response to acidic stomach contents (or bile acids) in the lungs. This occurs only if a large volume of material is aspirated.

Predisposing Factors for Aspiration Pneumonia

• Predisposing factors for the development of aspiration pneumonia include oropharyngeal dysphagia, inadequate management of respiratory secretions, esophageal malformations (like TEF), gastroesophageal reflux, and conditions impairing bacterial elimination.

Prevention of Aspiration Pneumonia

• Prevention strategies include swallowing therapy, oral hygiene, and management of respiratory factors.

Clinical Features of Aspiration Pneumonia

• Aspiration pneumonia is often acute, developing within hours to days.
• Symptoms may include fever, cough, and sputum production, coarse lung sounds, lung infiltrates on X-ray, and systemic inflammation.

Respiratory Factors Associated with Aspiration Pneumonia

• Conditions impacting respiratory rate, oxygen levels and the synchronization of swallow and breathing patterns were considered as risk factors
• Conditions impacting tongue and hyoid function were also identified.
• Problems with laryngeal function like adductor reflex, and laryngeal and pharyngeal contraction are risk factors.

Predictors of Aspiration Pneumonia

• Questions about predictors of aspiration pneumonia in the elderly were posed.
• Dysphagia was discussed as a possible predictor.