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Nursing Management and Clinical Outcomes of Aspiration Pneumonia in Intensive Care Units: A Critical Review of Evidence-Based Interventions and Risk Reduction Strategies
Corresponding Author(s) : Abdullah Fehaid Fadhad Alruqi
Saudi Journal of Medicine and Public Health,
Vol. 2 No. 2 (2025)
Abstract
Background: Aspiration pneumonia (AP) is a severe pulmonary infection resulting from the inhalation of oropharyngeal or gastric contents, leading to significant morbidity and mortality, particularly in intensive care units (ICUs). Distinguishing AP from aspiration pneumonitis is critical, as their management differs substantially. High-risk populations include elderly, neurologically impaired, and mechanically ventilated patients.
Aim: This review evaluates evidence-based nursing and medical interventions for AP management, focusing on prevention, early diagnosis, and treatment strategies to improve clinical outcomes.
Methods: A critical review of current literature was conducted (50 scanned, and 14 selected), analyzing risk factors, diagnostic approaches, medical treatments, and nursing interventions for AP. Emphasis was placed on multidisciplinary care, including pharmacological management, swallowing assessments, and respiratory support.
Results: Key findings highlight the importance of early antibiotic therapy, with amoxicillin, ampicillin-sulbactam, and respiratory fluoroquinolones as primary treatments. Non-pharmacological strategies, such as swallowing evaluations, dietary modifications, and oral hygiene, significantly reduce AP risk. Nursing interventions, including airway management, positioning, and continuous monitoring, are vital in preventing complications.
Conclusion: Effective AP management requires a multidisciplinary approach integrating prompt antibiotic therapy, risk factor modification, and vigilant nursing care. Early recognition and preventive measures can reduce mortality and improve patient outcomes.
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- Simpson AJ, Allen JL, Chatwin M, Crawford H, Elverson J, Ewan V, Forton J, McMullan R, Plevris J, Renton K, Tedd H, Thomas R, Legg J. BTS clinical statement on aspiration pneumonia. Thorax. 2023 Feb;78(Suppl 1):s3-s21.
- Teramoto S. The current definition, epidemiology, animal models and a novel therapeutic strategy for aspiration pneumonia. Respir Investig. 2022 Jan;60(1):45-55.
- Almirall J, Boixeda R, de la Torre MC, Torres A. Aspiration pneumonia: A renewed perspective and practical approach. Respir Med. 2021 Aug-Sep;185:106485.
- Košutova P, Mikolka P. Aspiration syndromes and associated lung injury: incidence, pathophysiology and management. Physiol Res. 2021 Dec 30;70(Suppl4):S567-S583.
- Yoshimatsu Y, Melgaard D, Westergren A, Skrubbeltrang C, Smithard DG. The diagnosis of aspiration pneumonia in older persons: a systematic review. Eur Geriatr Med. 2022 Oct;13(5):1071-1080.
- Mandell LA, Niederman MS. Aspiration Pneumonia. N Engl J Med. 2019 Feb 14;380(7):651-663.
- Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, Dowell SF, File TM, Musher DM, Niederman MS, Torres A, Whitney CG., Infectious Diseases Society of America. American Thoracic Society. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis. 2007 Mar 01;44 Suppl2(Suppl 2):S27-72.
- Metlay JP, Waterer GW, Long AC, Anzueto A, Brozek J, Crothers K, Cooley LA, Dean NC, Fine MJ, Flanders SA, Griffin MR, Metersky ML, Musher DM, Restrepo MI, Whitney CG. Diagnosis and Treatment of Adults with Community-acquired Pneumonia. An Official Clinical Practice Guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med. 2019 Oct 01;200(7):e45-e67.
- Komiya K, Rubin BK, Kadota JI, Mukae H, Akaba T, Moro H, Aoki N, Tsukada H, Noguchi S, Shime N, Takahashi O, Kohno S. Prognostic implications of aspiration pneumonia in patients with community acquired pneumonia: A systematic review with meta-analysis. Sci Rep. 2016 Dec 07;6:38097.
- Gupte T, Knack A, Cramer JD. Mortality from Aspiration Pneumonia: Incidence, Trends, and Risk Factors. Dysphagia. 2022 Dec;37(6):1493-1500.
- Won JH, Byun SJ, Oh BM, Park SJ, Seo HG. Risk and mortality of aspiration pneumonia in Parkinson's disease: a nationwide database study. Sci Rep. 2021 Mar 23;11(1):6597.]
- Yanagita Y, Arizono S, Tawara Y, Oomagari M, Machiguchi H, Yokomura K, Katagiri N, Iida Y. The severity of nutrition and pneumonia predicts survival in patients with aspiration pneumonia: A retrospective observational study. Clin Respir J. 2022 Jul;16(7):522-532.
- Kumar NR, Norwood BS. Sphingomonas Paucimobilis Pneumonia Complicated by Empyema in an Immunocompetent Patient: A Case Report and Concise Review of Literature. Cureus. 2022 May;14(5):e24820.
- Martinez K, Mangat GK, Sherwani N, Glover DO M, Silver Md M. Veillonella Intrapulmonary Abscess With Empyema. Cureus. 2023 Sep;15(9):e45210.
References
Simpson AJ, Allen JL, Chatwin M, Crawford H, Elverson J, Ewan V, Forton J, McMullan R, Plevris J, Renton K, Tedd H, Thomas R, Legg J. BTS clinical statement on aspiration pneumonia. Thorax. 2023 Feb;78(Suppl 1):s3-s21.
Teramoto S. The current definition, epidemiology, animal models and a novel therapeutic strategy for aspiration pneumonia. Respir Investig. 2022 Jan;60(1):45-55.
Almirall J, Boixeda R, de la Torre MC, Torres A. Aspiration pneumonia: A renewed perspective and practical approach. Respir Med. 2021 Aug-Sep;185:106485.
Košutova P, Mikolka P. Aspiration syndromes and associated lung injury: incidence, pathophysiology and management. Physiol Res. 2021 Dec 30;70(Suppl4):S567-S583.
Yoshimatsu Y, Melgaard D, Westergren A, Skrubbeltrang C, Smithard DG. The diagnosis of aspiration pneumonia in older persons: a systematic review. Eur Geriatr Med. 2022 Oct;13(5):1071-1080.
Mandell LA, Niederman MS. Aspiration Pneumonia. N Engl J Med. 2019 Feb 14;380(7):651-663.
Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, Dowell SF, File TM, Musher DM, Niederman MS, Torres A, Whitney CG., Infectious Diseases Society of America. American Thoracic Society. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis. 2007 Mar 01;44 Suppl2(Suppl 2):S27-72.
Metlay JP, Waterer GW, Long AC, Anzueto A, Brozek J, Crothers K, Cooley LA, Dean NC, Fine MJ, Flanders SA, Griffin MR, Metersky ML, Musher DM, Restrepo MI, Whitney CG. Diagnosis and Treatment of Adults with Community-acquired Pneumonia. An Official Clinical Practice Guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med. 2019 Oct 01;200(7):e45-e67.
Komiya K, Rubin BK, Kadota JI, Mukae H, Akaba T, Moro H, Aoki N, Tsukada H, Noguchi S, Shime N, Takahashi O, Kohno S. Prognostic implications of aspiration pneumonia in patients with community acquired pneumonia: A systematic review with meta-analysis. Sci Rep. 2016 Dec 07;6:38097.
Gupte T, Knack A, Cramer JD. Mortality from Aspiration Pneumonia: Incidence, Trends, and Risk Factors. Dysphagia. 2022 Dec;37(6):1493-1500.
Won JH, Byun SJ, Oh BM, Park SJ, Seo HG. Risk and mortality of aspiration pneumonia in Parkinson's disease: a nationwide database study. Sci Rep. 2021 Mar 23;11(1):6597.]
Yanagita Y, Arizono S, Tawara Y, Oomagari M, Machiguchi H, Yokomura K, Katagiri N, Iida Y. The severity of nutrition and pneumonia predicts survival in patients with aspiration pneumonia: A retrospective observational study. Clin Respir J. 2022 Jul;16(7):522-532.
Kumar NR, Norwood BS. Sphingomonas Paucimobilis Pneumonia Complicated by Empyema in an Immunocompetent Patient: A Case Report and Concise Review of Literature. Cureus. 2022 May;14(5):e24820.
Martinez K, Mangat GK, Sherwani N, Glover DO M, Silver Md M. Veillonella Intrapulmonary Abscess With Empyema. Cureus. 2023 Sep;15(9):e45210.