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Pulmonary aspiration during emergency endoscopy in patients with upper gastrointestinal hemorrhage
1Department of Medicine, Albert Einstein College of Medicine, Bronx Municipal Hospital Center, NY.
Objective:
To evaluate the frequency and significance of aspiration and its clinical importance in patients with upper GI bleeding undergoing esophagogastroduodenoscopy in the ICU.
Design:
Thirty consecutive patients with active and severe upper GI bleeding were studied.
Setting:
ICU.
Patients:
Ranged in age from 20 to 78 yr with an equal number of males and females.
Interventions:
All patients had continuous pulse oximetry monitoring and had chest radiographs obtained less than 12 hr before endoscopy and less than 4 hr after endoscopy.
Measurements:
Six (20%) of 30 patients developed new lung infiltrates after esophagogastroduodenoscopy. In this group of patients, preendoscopy chest radiographs were obtained after less than 4 hr. In five of these patients, infiltrates were accompanied by fever and/or leukocytosis and oxygen desaturation to less than 90% during the esophagogastroduodenoscopy.
Conclusion:
Clinically significant aspiration pneumonia frequently complicates esophagogastroduodenoscopy in upper GI bleeding patients and is an important mechanism of esophagogastroduodenoscopy-induced hypoxia.