Patient handout

Aspiration Pneumonia

PRODUCTION

1. Your condition

This handout is for aspiration pneumonia. Your care team identified this based on: witnessed aspiration / choking event.

Other reasons your team may use this plan: cough, fever, dyspnea after dysphagia/altered loc; dependent-lobe infiltrate (rll, posterior segments) on cxr/ct; high-aspiration-risk substrate — stroke, dementia, als, esophageal dysmotility, ng tube, intoxication.

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
oxygen	1–6 L/min NC titrated	inhaled	continuous PRN to SpO2 ≥92%	Supportive only — chemical pneumonitis typically resolves in 24–48 h; antibiotics do NOT alter the course of pure pneumonitis and select resistance / C. difficile (Marik NEJM 2001 PMID 11228282; Mandell NEJM 2019 PMID 30763196). RxCUI RxNav-confirmed 2026-05-16.

Plan: Aspiration: when-to-treat fork + empirical antibiotics WITHOUT routine anaerobic coverage (Metlay ATS/IDSA 2019 PMID 31573350; Mandell NEJM 2019 PMID 30763196; Marik NEJM 2001 PMID 11228282)

3. When to call your provider

Contact your care team if any of the following happen:

Worsening dyspnea / hypoxia → ED (ATS/IDSA 2019)
Fever ≥72 h → ED (ATS/IDSA 2019)
Recurrent aspiration → outpatient swallow rehab (DeLegge 2002)

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

Large-volume acid aspiration with rapidly progressive bilateral infiltrates + hypoxemia (P/F ≤300) within hours — Mendelson syndrome evolving to ARDS(life-threatening)
Vasopressor requirement OR lactate ≥4 OR SBP <90 unresponsive to fluids in aspiration pneumonia (ATS/IDSA 2019)(life-threatening)
Cavitating consolidation OR loculated lesion ≥2 cm with air-fluid level on CT — one of the FEW remaining indications for anaerobic coverage (Mandell NEJM 2019 PMID 30763196; Bartlett 2013 PMID 23398871)
Pleural fluid pH <7.20 OR pus on thoracentesis OR loculated pleural collection with sepsis (ATS/IDSA 2019)
Witnessed choking event with persistent unilateral wheeze, persistent atelectasis, or post-obstructive pneumonia (Marik 2001)
Aspiration occurring ≥48 h after hospital admission, post-extubation aspiration, or vent-associated pneumonia (IDSA/ATS 2016 HAP/VAP)

5. Follow-up

Secondary prevention bundle — speech-language pathology swallow rehab, diet/texture modification, oral-hygiene programme, head-of-bed elevation, sedative/anticholinergic deprescribing, vaccination, goals-of-care discussion for recurrent aspiration (PEG does NOT eliminate aspiration risk) (Mandell 2019 PMID 30763196; Sherman/Martino JAHA 2021 PMID 34096328)

6. Sources

Guideline: Marik NEJM 2001 pneumonitis-vs-pneumonia framework (PMID 11228282) + Mandell & Niederman NEJM 2019 aspiration review (PMID 30763196) + ATS/IDSA 2019 CAP guideline — recommends AGAINST routine anaerobic coverage (Metlay PMID 31573350) + ATS 2025 CAP short-course overlap + ATS HAP/VAP 2016 (nosocomial)