title: Incidence, risk factors, and outcome of aspiration pneumonitis in ICU overdose patients.
abstract: OBJECTIVE
  To assess the incidence and outcome of clinically significant aspiration pneumonitis in intensive care unit (ICU) overdose patients and to identify its predisposing factors.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Medical ICU of an academic tertiary care hospital.
  
  
  METHODS
  A total of 273 consecutive overdose admissions.
  
  
  RESULTS
  Clinically significant aspiration pneumonitis was defined as the occurrence of respiratory dysfunction in a patient with a localised infiltrate on chest X-ray within 72 h of admission. In our cohort we identified 47 patients (17%) with aspiration pneumonitis. Importantly, aspiration pneumonitis was associated with a higher incidence of cardiac arrest (6.4 vs 0.9%; p = 0.037) and an increased duration of both ICU stay and overall hospital stay [respectively: median 1 (interquartile range 1-3) vs 1 (1-2), p = 0.025; and median 2 (1-7) vs 1 (1-3), p < 0.001]. In multivariate logistic regression analysis, Glasgow Coma Scale (GCS) score [odds ratio (OR) for each point of GCS 0.8; 95% confidence interval (CI) 0.7-0.9; p = 0.001], ingestion of opiates (OR 4.5; 95% CI 1.7-11.6; p = 0.002), and white blood cell count (WBC) (OR for each increase in WBC of 10(9)/l 1.05; 95% CI 1.0-1.19; p = 0.049) were identified as independent risk factors.
  
  
  CONCLUSIONS
  Clinically relevant aspiration pneumonitis is a frequent complication in overdose patients admitted to the ICU. Moreover, aspiration pneumonitis is associated with a higher incidence of cardiac arrest and increased ICU and total in-hospital stay.
authors.affiliation: Department of Internal Medicine, University of Basel, University Hospital, Petersgraben 4, 4031 Basel, Switzerland.
authors.forename: Andreas
authors.initials: A
authors.lastname: Christ
authors.forename: Christian A
authors.initials: CA
authors.lastname: Arranto
authors.forename: Christian
authors.initials: C
authors.lastname: Schindler
authors.forename: Theresia
authors.initials: T
authors.lastname: Klima
authors.forename: Patrick R
authors.initials: PR
authors.lastname: Hunziker
authors.forename: Martin
authors.initials: M
authors.lastname: Siegemund
authors.forename: Stephan C
authors.initials: SC
authors.lastname: Marsch
authors.forename: Urs
authors.initials: U
authors.lastname: Eriksson
authors.forename: Christian
authors.initials: C
authors.lastname: Mueller
mesh_terms: D000328:Adult; D016009:Chi-Square Distribution; D062787:Drug Overdose / Q000150:complications*; D005260:Female; D006323:Heart Arrest / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011015:Pneumonia, Aspiration / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000209:etiology*; D011859:Radiography; D012189:Retrospective Studies; D012307:Risk Factors; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D016896:Treatment Outcome