ICU · Airway management

Aspiration — Prevention & Management (Pneumonitis vs Pneumonia)

Also known as Aspiration · Aspiration pneumonitis · Mendelson syndrome · Aspiration pneumonia · Ventilator-associated pneumonia · VAP prevention · Subglottic suction · Semi-recumbent position · Post-extubation dysphagia · Chemical pneumonitis · Cuff pressure monitoring · Silent aspiration

Aspiration causes two distinct syndromes. Aspiration pneumonitis (Mendelson syndrome) is a sterile chemical injury from acidic gastric contents — treated with supportive care (oxygen, positive pressure, bronchodilators), with antibiotics and corticosteroids NOT given routinely. Aspiration pneumonia is an infection from aspiration of colonised oropharyngeal secretions (the elderly, dysphagia, poor dentition, reduced consciousness) — treated with antibiotics. The distinction drives treatment. Prevention is the VAP bundle: head of bed 30-45 degrees (Drakulovic, Lancet 1999), subglottic suction, cuff pressure 20-30 cmH2O, oral hygiene, minimal sedation, and post-pyloric feeding for the high-risk patient. Proton pump inhibitors for stress ulcer prophylaxis have NO mortality benefit (SUP-ICU, Krag NEJM 2018).