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Semin Respir Crit Care Med 2024; 45(06): 650-658
DOI: 10.1055/s-0044-1791739
Review Article

Is There a Role for Bronchoscopy in Aspiration Pneumonia?

Andrei M. Darie
1   Clinic of Respiratory Medicine, University Hospital Basel, Switzerland
,
Daiana Stolz
2   Clinic of Respiratory Medicine, University of Freiburg, Germany
3   Faculty of Medicine, University of Freiburg, Germany
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Abstract

Aspiration represents the passage of oropharyngeal content to the lower respiratory tract. The interplay between the host and the aspirate proprieties determines the subsequent aspiration syndrome. A low pH, typical of gastric aspirate, favors chemical pneumonitis, whereas an increased bacterial inoculum causes aspiration pneumonia. About a quarter of patients with aspiration pneumonitis will develop a bacterial superinfection during the course of recovery. While antibiotic therapy is indicated for aspiration pneumonia, supportive care remains the cornerstone of treatment in aspiration pneumonitis. However, the overlapping clinical features of these syndromes lead to initiation of antimicrobial therapy in most cases of aspiration. Bronchoscopy can aid in clinical decision-making by direct airway visualization and also by providing access to a series of emerging biomarkers. Invasive microbiological studies increase diagnostic yield and enable a tailored antibiotic treatment. In conjunction with stewardship programs, invasive sampling and novel molecular diagnostics can decrease the amount of inappropriate antibiotic therapy. In the context of foreign body aspiration, bronchoscopy represents both diagnostic and treatment gold standard.

Keywords

aspiration pneumonia - aspiration pneumonitis - FBA bronchoscopy


Publication History

Article published online:
24 October 2024

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