Pulmonary aspiration during emergency endoscopy in patients with upper gastrointestinal hemorrhage

Abstract

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 <12 hr before endoscopy and <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 <4 hr. In five of these patients, infiltrates were accompanied by fever and/or leukocytosis and oxygen desaturation to <90% during the esophagogastroduodenoscopy. Conclusion. Clinically significant aspiration pneumonia frequently complicates esophagogastroduodenoscopy in upper GI bleeding patients and is an important mechanism of esophagogstroduodenoscopy-induced hypoxia. (Crit Care Med 1991; 19:330)