Tests
1st tests to order
O2 saturation
Test
Should be obtained if suspected aspiration.
Result
decreased
CXR
Test
Should be ordered if suspected aspiration.[Figure caption and citation for the preceding image starts]: Early ill-defined opacities of the right upper lobe above the minor fissure consistent with early changes of aspiration pneumoniaUsed with kind permission from Roy Hammond, MD [Citation ends].
[Figure caption and citation for the preceding image starts]: Increased opacification of the right perihilar region and superior segment of the right lower and upper lobes consistent with worsening aspiration pneumoniaUsed with kind permission from Roy Hammond, MD [Citation ends].
Result
new infiltrate in dependent lung fields
CBC
Test
Leukocytosis is common in aspiration pneumonia.
Result
leukocytosis
sputum Gram stain
Test
Requires an adequate specimen (i.e., uncontaminated by saliva), which may be difficult to obtain.
Result
WBCs and mixed organisms
sputum culture
Test
Anaerobes are difficult to culture and require a specimen from the distal lung.
Result
oral flora
Tests to consider
point-of-care lung ultrasound
Test
Should be considered if the CXR is negative and the patient is elderly and frail or the clinical suspicion is uncertain.[40] The American College of Physicians recommends point-of-care ultrasound if there is diagnostic uncertainty in patients with acute dyspnea.[41]
Result
consolidation may be seen
ABG
Test
Should be carried out if there is worsening oxygenation, increased work of breathing, and other systemic signs of organ dysfunction.
Result
decreased oxygen saturation and acidosis if patient moderately to severely ill
bronchoscopy
Test
The most common sampling technique is bronchoalveolar lavage.
Bronchoscopic-protected specimen brush samples, the method whereby one obtains anaerobic cultures, are not commonly performed in clinical practice.
Limited to removal of large particulate matter or a foreign body when present.
Result
aerobic respiratory culture
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