How is chemical pneumonitis treated?

Updated: Aug 15, 2018
  • Author: Justina Gamache, MD; Chief Editor: Guy W Soo Hoo, MD, MPH  more...
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The treatment of individuals with chemical pneumonitis should include maintenance of the airways and clearance of secretions with tracheal suctioning, oxygen supplementation, and mechanical ventilation as necessary. If the patient is unable to maintain adequate oxygenation despite a high fraction of inspired oxygen, positive end-expiratory pressure (PEEP) should be considered. The routine use of corticosteroids is not recommended, because supporting studies, both animal and human, are not convincing of a favorable benefit-to-risk ratio. The early prophylactic (before evidence of a bacterial pneumonia) use of antibiotics in chemical pneumonitis, although widely practiced, is not supported by evidence.

Choosing antibiotics based on organisms cultured from sputum, tracheal aspirates, or aspirate obtained through a protected catheter by bronchoscopy rather than empirically is more appropriate. However, because the chemically injured bronchi and lungs are very susceptible to bacterial infection, it is reasonable to use antimicrobial agents based on the probability of the bacteria, the severity of the pneumonia, patient-related risk factors (eg, malnutrition, comorbid illnesses), intervention-related factors (eg, previous use of antibiotics, corticosteroids, cytotoxic agents, endotracheal tube), and the duration of hospitalization.

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