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Aspiration pneumonia following severe self-poisoning
Janne Liisanantti1, Päivi Kaukoranta, Matti Martikainen
1Department of Anesthesiology, Oulu University Hospital, PO Box 21, 90029 OUH, Oulu, Finland.
Purpose:
To investigate the risk factors of aspiration pneumonia following severe self-poisoning.
Materials And Methods:
Patients treated due to severe self-poisoning in the ICU of Oulu University Hospital, Oulu, Finland during 1.11.1989-31.10.2000 were analyzed retrospectively.
Results:
28.4% of 257 patients fulfilled the criteria of aspiration pneumonia. An unconscious patient who was not intubated until arrival at the emergency room (ER) had an odds ratio (OR) of 3.34 (CI 1.3-8.7) for aspiration pneumonia. If the patient was intubated at the first contact with health care providers, OR was 1.8 (CI 0.6-5.7). The use of gastric lavage or activated charcoal in the case of a non-intubated unconscious patient led to ORs of 2.7 (CI 0.8-9.3) and 3.7 (CI 1.01-12.5), respectively. The mean length of ICU stay was 0.9 (CI 0.8-0.9) days among patients without aspiration pneumonia and 1.9 (CI 1.3-2.6) days among those with aspiration pneumonia. The mean length of hospital stay was 2.8 (CI 2.5-3.1) days among the patients without aspiration pneumonia and 6.5 (CI 5.3-7.6) days among those with aspiration pneumonia.
Conclusion:
To avoid aspiration pneumonia intubation of an unconscious patient on scene before arrival at the ER is recommended. The use of gastric lavage and activated charcoal increase the risk of aspiration pneumonia if the patient is unconscious and not intubated. Aspiration pneumonia significantly prolongs the length of ICU and hospital stay.