Pulmonary aspiration during emergency endoscopy in patients with upper gastrointestinal hemorrhage.

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.