Acute aspiration

Overview 
Theory 
Diagnosis 
Management 
Follow up 
Resources 

Last reviewed: 10 Aug 2025

Last updated: 01 Sep 2020

The inhalation of foreign material into the airways beyond the vocal cords.

Usually occurs in patients with altered level of consciousness, dysphagia, or impaired cough reflex.

Patients with risk factors for aspiration should undergo a bedside clinical exam before feeding.

Anesthesia-related aspiration of gastric contents can be prevented by identifying patients susceptible to vomiting and reflux, minimizing gastric contents before surgery, minimizing emetic stimuli, and avoiding complete loss of protective reflexes from oversedation.

Antibiotics are not indicated early after aspiration of gastric contents but they should be considered if the pneumonitis does not resolve after 48 hours.

Patients with neurologic deficits, infants, older patients (age >70 years), and debilitated patients with dysphagia may also aspirate barium sulfate during radiologic procedures, which can result in severe pneumonitis.

Definition

Aspiration is the inhalation of liquid or solid particles, particularly food, into the airways beyond the vocal cords.[1] It can be categorized as aspiration pneumonitis or aspiration pneumonia. Aspiration pneumonitis is a chemical injury after aspiration of gastric contents. Aspiration pneumonia is an infectious process secondary to aspiration of orogastric contents colonized with bacteria.[2][1] This topic does not discuss the inhalation of foreign bodies.

History and exam

Key diagnostic factors

intractable cough
fever
dyspnea
wheezing
crackles

Full details

Risk factors

decreased level of consciousness (Glasgow coma scale score <9)
increased severity of illness
general anesthesia
age >70 years
male sex
head trauma
cerebrovascular disease
endotracheal or tracheostomy tube
dysphagia
airway difficulties
barium meal
gastroesophageal reflux disease
feeding tubes
supine position
delayed gastric emptying
obesity
drugs that reduce esophageal sphincter tone

Full details

Diagnostic tests

1st tests to order

chest x-ray

Full details

Tests to consider

chest CT
bronchoscopy with bronchoalveolar lavage
CBC
arterial blood gases

Full details

Treatment algorithm

ACUTE

pneumonitis due to aspiration of gastric contents

pneumonitis due to aspiration of barium

ONGOING

nonresolving pneumonitis after 48 hours

Contributors

Authors

Madison Macht, MD

Volunteer Clinical Faculty

Division of Pulmonary Sciences and Critical Care Medicine

University of Colorado Denver

Aurora

Disclosures

MM declares that he has no competing interests.

Acknowledgements

Dr Madison Macht would like to gratefully acknowledge Dr Kamran Mahmood, Dr Scott Shofer, Dr Septimiu Murgu, and Dr Henri Colt, previous contributors to this topic.

Disclosures

KM, SS, SM, and HC declare that they have no competing interests.

Peer reviewers

Andrew Parfitt, MBBS, FFAEM

Clinical Director

Acute Medicine

Associate Medical Director

Consultant Emergency Medicine

Guy's and St Thomas' NHS Foundation Trust

Clinical Lead and Consultant

Accident and Emergency Medicine

St Thomas' Hospital

London

Disclosures

AP declares that he has no competing interests.

Momen M. Wahidi, MD, MBA

Director

Interventional Pulmonology

Division of Pulmonary, Allergy, and Critical Care Medicine

Assistant Professor of Medicine

Duke University Medical Center

Durham

Disclosures

MMW declares that he has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Marik PE. Aspiration pneumonitis and aspiration pneumonia. N Engl J Med. 2001 Mar 1;344(9):665-71. Abstract

Ng A, Smith G. Gastroesophageal reflux and aspiration of gastric contents in anesthetic practice. Anesth Analg. 2001 Aug;93(2):494-513.Full text Abstract

Metheny NA, Clouse RE, Chang YH, et al. Tracheobronchial aspiration of gastric contents in critically ill tube-fed patients: frequency, outcomes, and risk factors. Crit Care Med. 2006 Apr;34(4):1007-15.Full text Abstract

Smith Hammond CA, Goldstein LB. Cough and aspiration of food and liquids due to oral-pharyngeal dysphagia: ACCP evidence-based clinical practice guidelines. Chest. 2006 Jan;129(1 suppl):154S-68S.Full text Abstract

Boyd M, Chatterjee A, Chiles C, et al. Tracheobronchial foreign body aspiration in adults. South Med J. 2009 Feb;102(2):171-4. Abstract

Paintal HS, Kuschner WG. Aspiration syndromes: 10 clinical pearls every physician should know. Int J Clin Pract. 2007 May;61(5):846-52. Abstract

Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: Application to healthy patients undergoing elective procedures: an updated report by the American Society of Anesthesiologists Task Force on preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration. Anesthesiology. 2017 Mar;126(3):376-93.Full text Abstract

Australian and New Zealand Society for Geriatric Medicine. Australian and New Zealand Society for Geriatric Medicine. Position statement - dysphagia and aspiration in older people. Australas J Ageing. 2011 Jun;30(2):98-103. Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Differentials
- Acute respiratory distress syndrome
- Asthma exacerbation
- Cystic fibrosis with exacerbation
More Differentials
Guidelines
- Diagnosis and treatment of adults with community-acquired pneumonia: an official clinical practice guideline
- ACR appropriateness criteria: dysphagia
More Guidelines
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Acute aspiration

Summary

Definition

History and exam

Key diagnostic factors

Risk factors

Diagnostic tests

1st tests to order

Tests to consider

Treatment algorithm

pneumonitis due to aspiration of gastric contents

pneumonitis due to aspiration of barium

nonresolving pneumonitis after 48 hours

Contributors

Authors

Madison Macht, MD

Disclosures

Acknowledgements

Disclosures

Peer reviewers

Andrew Parfitt, MBBS, FFAEM

Disclosures

Momen M. Wahidi, MD, MBA

Disclosures

Peer reviewer acknowledgements

Disclosures

References

Key articles

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Differentials

Guidelines

Log in or subscribe to access all of BMJ Best Practice

Log in or subscribe to access all of BMJ Best Practice

Log in to access all of BMJ Best Practice