Incidence, risk factors, and outcome of aspiration pneumonitis in ICU overdose patients.
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.
Christ
Andreas
A
Department of Internal Medicine, University of Basel, University Hospital, Petersgraben 4, 4031 Basel, Switzerland.
Arranto
Christian A
CA
Schindler
Christian
C
Klima
Theresia
T
Hunziker
Patrick R
PR
Siegemund
Martin
M
Marsch
Stephan C
SC
Eriksson
Urs
U
Mueller
Christian
C
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