title: Respiratory complications in outpatient endoscopy with endoscopist-directed sedation.
abstract: OBJECTIVE
  Respiratory complications represent an important adverse event of endoscopic procedures. We screened for respiratory complications after endoscopic procedures using a questionnaire and followed-up patients suggestive of respiratory infection.
  
  
  METHODS
  In this prospective observational, multicenter study performed in Outpatient practices of gastroenterology we investigated 15,690 patients by questionnaires administered 24 hours after the endoscopic procedure.
  
  
  RESULTS
  832 of the 15,690 patients stated at least one respiratory symptom after the endoscopic procedure: 829 patients reported coughing (5.28%), 23 fever (0.15%) and 116 shortness of breath (SOB, 0.74%); 130 of the 832 patients showed at least two concomitant respiratory symptoms (107 coughing + SOB, 17 coughing + fever, 6 coughing + coexisting fever + SOB) and 126 patients were followed-up to assess their respiratory complaints. Twenty-nine patients (follow-up: 22.31%, whole sample: 0.18%) reported signs of clinically evident respiratory infection and 15 patients (follow-up: 11.54%; whole sample: 0.1%) received therefore antibiotic treatment. Coughing or vomiting during the endoscopic procedure resulted in a 156.12-fold increased risk of respiratory complications (95% CI: 67.44 - 361.40) and 520.87-fold increased risk of requiring antibiotic treatment (95% CI: 178.01 - 1524.05). All patients of the follow-up sample who coughed or vomited during endoscopy developed clinically evident signs of respiratory infection and required antibiotic treatment while this occurred in a significantly lower proportion of patients without these symptoms (17.1% and 5.1%, respectively).
  
  
  CONCLUSIONS
  We demonstrated that respiratory complications following endoscopic sedation are of comparably high incidence and we identified major predictors of aspiration pneumonia which could influence future surveillance strategies after endoscopic procedures.
authors.affiliation: University Hospital of Heidelberg, Department IV, Heidelberg, Germany. Heidelberg, Germany. Kilian.Friedrich@med.uni-heidelberg.de.
authors.forename: Kilian
authors.initials: K
authors.lastname: Friedrich
authors.affiliation: Department of Social Psychology, University of Mannheim, Mannheim, Germany.
authors.forename: Sabine G
authors.initials: SG
authors.lastname: Scholl
authors.affiliation: University Hospital of Heidelberg, Department IV, Heidelberg, Germany. Heidelberg, Germany.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Beck
authors.affiliation: University Hospital of Heidelberg, Department IV, Heidelberg, Germany. Heidelberg, Germany.
authors.forename: Daniel
authors.initials: D
authors.lastname: Gotthardt
authors.affiliation: University Hospital of Heidelberg, Department IV, Heidelberg, Germany. Heidelberg, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Stremmel
authors.affiliation: Indiana University Hospital, Department of Gastroenterology, Indianapolis, IN, USA.
authors.forename: Douglas K
authors.initials: DK
authors.lastname: Rex
authors.affiliation: University Hospital of Heidelberg, Department IV, Heidelberg, Germany. Heidelberg, Germany; Practice of Gastroenterology, Heidelberg, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Sieg
mesh_terms: D061605:Administration, Intravenous; D000328:Adult; D000368:Aged; D000553:Ambulatory Care; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016292:Procedural Sedation / Q000009:adverse effects*; D003371:Cough / Q000139:chemically induced / Q000453:epidemiology; D054810:Deep Sedation / Q000009:adverse effects*; D016145:Endoscopy, Digestive System / Q000009:adverse effects*; D005260:Female; D005334:Fever / Q000139:chemically induced / Q000453:epidemiology; D005858:Germany / Q000453:epidemiology; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000009:adverse effects*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011015:Pneumonia, Aspiration / Q000453:epidemiology; D015742:Propofol / Q000008:administration & dosage / Q000009:adverse effects*; D011446:Prospective Studies; D012120:Respiration Disorders / Q000139:chemically induced / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D012141:Respiratory Tract Infections / Q000139:chemically induced / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014839:Vomiting / Q000139:chemically induced / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents; D006993:Hypnotics and Sedatives; D015742:Propofol