Chemical pneumonitis: Difference between revisions
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'''Editor(s)-in-Chief:''' [[C. Michael Gibson, M.S., M.D.]] [mailto:mgibson@perfuse.org] Phone:617-632-7753; [[Philip Marcus, M.D., M.P.H.]][mailto:pmarcus192@aol.com] | '''Editor(s)-in-Chief:''' [[C. Michael Gibson, M.S., M.D.]] [mailto:mgibson@perfuse.org] Phone:617-632-7753; [[Philip Marcus, M.D., M.P.H.]][mailto:pmarcus192@aol.com] | ||
==Historical perspective== | ==Historical perspective== | ||
* [[Mendelson's syndrome]] is a type of chemical Chemical pneumonitis in which aspiration of gastric acid is present. | * [[Mendelson's syndrome]] is a type of chemical Chemical pneumonitis in which aspiration of gastric acid is present. | ||
Revision as of 17:25, 8 September 2012
| Chemical pneumonitis | ||
| ICD-10 | J12, J13, J14, J15, J16, J17, J18, P23 | |
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| ICD-9 | 480-486, 770.0 | |
| DiseasesDB | 10166 | |
| MeSH | pneumonitis&field=entry#TreeC08.381.677 C08.381.677 | |
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Chemical pneumonitis Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
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Chemical pneumonitis On the Web |
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American Roentgen Ray Society Images of Chemical pneumonitis |
For patient information click here
Editor(s)-in-Chief: C. Michael Gibson, M.S., M.D. [1] Phone:617-632-7753; Associate Editor(s)-In-Chief: Priyamvada Singh, M.D. [2]; Philip Marcus, M.D., M.P.H.[3]
Overview
Historical Perspective
Pathophysiology
Causes
- Specific causes: Bacterial | Fungal | Parasitic | Viral
- Classification scheme: Community-acquired Chemical pneumonitis | Health-care associated Chemical pneumonitis
- Other types: Severe acute respiratory syndrome | Bronchiolitis obliterans organizing Chemical pneumonitis | Eosinophilic Chemical pneumonitis | Aspiration Chemical pneumonitis (Chemical pneumonitis | Aspiration Chemical pneumonitis bacterial infection | Airway obstruction)
Differentiating Chemical pneumonitis from other Diseases
Epidemiology and Demographics
Risk factors
Natural History, Complications and Prognosis
Prognosis predictor scores: CURB-65 | Chemical pneumonitis severity index | Criteria for severe community acquired Chemical pneumonitis
Diagnosis
Diagnostic criteria | History and Symptoms | Physical Examination | Laboratory Findings | Chest X Ray
Treatment
Site of care decision | Medical Therapy | Other treatments consideration | Prevention | Management of non-responding Chemical pneumonitis
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Chemical pneumonitis Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
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Chemical pneumonitis On the Web |
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American Roentgen Ray Society Images of Chemical pneumonitis |
Editor(s)-in-Chief: C. Michael Gibson, M.S., M.D. [4] Phone:617-632-7753; Philip Marcus, M.D., M.P.H.[5]
Historical perspective
- Mendelson's syndrome is a type of chemical Chemical pneumonitis in which aspiration of gastric acid is present.
- It was first described in pregnant females who aspirated gastric content during anesthesia, with development of respiratory distress, cyanosis and lung infiltrates on chest Xray [1].
Natural History, Complications and Prognosis
Prognosis
- Approximately, 3 in 5 patients have clinical improvement with clearing of chest Xray.
- Approximately, 1 in every 3rd patient shows a rapid improvement followed with a new progressive infiltrate suggesting secondary superimposed bacterial infection or the development of ARDS.
- The least common course but with worst prognosis is the development of fulminant disease resulting in acute death.
History & Symptoms
Physical examination
Vitals
- Tachypnea
- Tachycardia
- Fever
- Hypoxemia on pulse oximetry
General
Lung
Auscultation
Diagnosis
- Documented aspiration may be absent or present
- History, symptoms, physical examination
- CXR with infiltrates in dependent pulmonary lobe
- Bronchoscopy - Bronchial inflammation
Chest XRay
- Infiltrates on chest Xray
- Either unilateral or bilateral
- Commonly in the dependent pulmonary segment
- Dependent lobes in the upright position are the lower lobes
- Dependent lobes in recumbent position are superior segments of the lower lobes and the posterior segments of the upper lobes.
Bronchoscopy
- Erythema of the bronchi
Medical therapy
- Tracheal suction (observed aspiration). However, the initial lung injury can't be prevented as it occurs rapidly
Supportive Pulmonary therapy
- Positive pressure ventilation
- Intravenous fluids (high molecular weight colloid)
- Sodium nitroprusside infusion in the pulmonary artery
- Mechanical ventilation (if respiratory failure)
- Antimicrobial agents prophylactically for superimposed bacterial infection
- Use of steroids is controversial