title: Risk factors for unexpected death from suffocation in elderly patients hospitalized for pneumonia.
abstract: OBJECTIVE
  Unexpected death from suffocation as a result of ortholaryngeal mucinous secretions or vomitus during recovery from pneumonia is devastating for patients, their families and medical professionals. This study aimed to determine the risk factors for unexpected death from suffocation in elderly patients hospitalized for pneumonia.
  
  
  METHODS
  This study was carried out with patients aged 65 years and older that were hospitalized for pneumonia and died of any cause. Unexpected death from suffocation was defined as: (i) being in the recovery stage of pneumonia; (ii) presenting stable vital signs a week before death; (iii) dying within 24 h after suffocation; and (iv) aspiration confirmed by transtracheal suction. The clinical features and courses, and methods of feeding were retrospectively analyzed.
  
  
  RESULTS
  A total of 11 patients that had an unexpected death from suffocation and 62 patients who died of other causes were enrolled. There were significantly more patients that received tube feeding after admission (continuation and introduction) among the patients who had died of suffocation (63.6%) than in those who had died of other causes (12.9%; P < 0.001). A multiple logistic regression analysis showed that tube feeding after admission was strongly associated with unexpected death from suffocation (adjusted odds ratio 9.536, P = 0.047) after adjusting for sex, age, level of serum albumin, PaO2 /FIO2 ratio, the pneumonia severity score and performance status.
  
  
  CONCLUSIONS
  A continuation of tube feeding after admission is thus considered to be a significant predictor of unexpected death from suffocation in elderly patients with pneumonia.
authors: Internal Medicine 2, Oita University Faculty of Medicine, Oita, Japan. komiyakh1@oita-u.ac.jp
authors: Kosaku
authors: K
authors: Komiya
authors: Hiroshi
authors: H
authors: Ishii
authors: Eiji
authors: E
authors: Okabe
authors: Tomohiko
authors: T
authors: Iwashita
authors: Hajime
authors: H
authors: Miyajima
authors: Tetsuo
authors: T
authors: Tsubone
authors: Minoru
authors: M
authors: Ohama
authors: Hisako
authors: H
authors: Kushima
authors: Bunroku
authors: B
authors: Matsumoto
authors: Jun-ichi
authors: J
authors: Kadota
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001237:Asphyxia / Q000401:mortality*; D002423:Cause of Death; D015331:Cohort Studies; D018450:Disease Progression; D004750:Enteral Nutrition / Q000706:statistics & numerical data; D005260:Female; D005774:Gastrostomy / Q000706:statistics & numerical data; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007441:Intubation, Gastrointestinal / Q000706:statistics & numerical data; D007564:Japan / Q000453:epidemiology; D008297:Male; D010288:Parenteral Nutrition / Q000706:statistics & numerical data; D010343:Patient Admission / Q000706:statistics & numerical data; D018410:Pneumonia, Bacterial / Q000453:epidemiology*; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors