Aspiration — the pneumonitis versus the pneumonia

The aspiration pneumonitis:

• The chemical, the sterile injury from the gastric acid.
• The rapid onset (the hours), the hypoxia, the wheeze, the bilateral infiltrates.
• The common in the obstetric (the pregnant, the full stomach) and the anaesthetic patient.
• The management: the supportive (the oxygen, the airway protection, the observation). The NO routine antibiotics (unless the secondary infection). The corticosteroids and the lavage NOT recommended.^[1]

The aspiration pneumonia:

• The bacterial infection from the oropharyngeal contents.
• The insidious onset (the days), the fever, the cough, the purulent and the foul-smelling sputum (the anaerobes).
• The risk factors — reduced glottic competency (extreme age, esophageal neuromuscular disease, intubation, impaired consciousness), altered consciousness, alcohol and poor dentition.
• Ill-defined infiltrates with hypoxia — a disease of exclusion; most events are silent or unwitnessed.
• The management: scenario-matched antibiotics — extended anaerobic cover beyond CAP therapy added no mortality benefit; the putrid abscess is the clindamycin domain.^[1]

The key distinction: the pneumonitis is the sterile chemical injury (supportive), the pneumonia is the bacterial infection (antibiotics) — though differentiation can be very difficult. The foul-smelling sputum and fever favour the pneumonia.^[1]