title: Acute emergency care and airway management of caustic ingestion in adults: single center observational study.
abstract: BACKGROUND
  Caustic ingestions are rare but potentially life-threatening events requiring multidisciplinary emergency approaches. Although particularly respiratory functions may be impaired after caustic ingestions, studies involving acute emergency care are scarce. The goal of this study was to explore acute emergency care with respect to airway management and emergency department (ED) infrastructures.
  
  
  METHODS
  We retrospectively evaluated adult patients after caustic ingestions admitted to our university hospital over a 10-year period (2005-2014). Prognostic analysis included age, morbidity, ingested agent, airway management, interventions (endoscopy findings, computed tomography (CT), surgical procedures), intensive care unit (ICU) admission, length of stay in hospital and hospital mortality.
  
  
  RESULTS
  Twenty-eight patients with caustic ingestions were included in the analysis of which 18 (64%) had suicidal intentions. Ingested agents were caustic alkalis (n = 22; 79%) and acids (n = 6; 21%). ICU admission was required in 20 patients (71%). Fourteen patients (50%) underwent tracheal intubation and mechanical ventilation, of which 3 (21%) presented with difficult airways. Seven patients (25%) underwent tracheotomy including one requiring awake tracheotomy due to progressive upper airway obstruction. Esophagogastroduodenoscopy (EGD) was performed in 21 patients (75%) and 11 (39%) underwent CT examination. Five patients (18%) required emergency surgery with a mortality of 60%. Overall hospital mortality was 18% whereas the need for tracheal intubation (P = 0.012), CT-diagnostic (P = 0.001), higher EGD score (P = 0.006), tracheotomy (P = 0.048), and surgical interventions (P = 0.005) were significantly associated with mortality.
  
  
  CONCLUSIONS
  Caustic ingestions in adult patients require an ED infrastructure providing 24/7-availability of expertise in establishing emergent airway safety, endoscopic examination (EGD and bronchoscopy), and CT diagnostic, intensive care and emergency esophageal surgery. We recommend that - even in patients with apparently stable clinical conditions - careful monitoring of respiratory functions should be considered as long as diagnostic work-up is completed.
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, University Hospital Leipzig, Liebigstr. 20, 04103, Leipzig, Germany. manuelstruck@web.de.
authors.forename: Manuel F
authors.initials: MF
authors.lastname: Struck
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, University Hospital Leipzig, Liebigstr. 20, 04103, Leipzig, Germany.
authors.forename: André
authors.initials: A
authors.lastname: Beilicke
authors.affiliation: Department of Gastroenterology and Rheumatology, Section of Interdisciplinary Endoscopy and Sonography, University Hospital Leipzig, Leipzig, Germany.
authors.forename: Albrecht
authors.initials: A
authors.lastname: Hoffmeister
authors.affiliation: Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital Leipzig, Leipzig, Germany.
authors.forename: Ines
authors.initials: I
authors.lastname: Gockel
authors.affiliation: Emergency Department, University Hospital Leipzig, Leipzig, Germany.
authors.forename: André
authors.initials: A
authors.lastname: Gries
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, University Hospital Leipzig, Liebigstr. 20, 04103, Leipzig, Germany.
authors.forename: Hermann
authors.initials: H
authors.lastname: Wrigge
authors.affiliation: Emergency Department, University Hospital Leipzig, Leipzig, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Bernhard
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D058109:Airway Management / Q000379:methods*; D002424:Caustics / Q000008:administration & dosage* / Q000506:poisoning*; D003422:Critical Care; D004326:Drinking; D004636:Emergency Service, Hospital; D016145:Endoscopy, Digestive System; D005260:Female; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D012189:Retrospective Studies; D013514:Surgical Procedures, Operative; D055815:Young Adult
chemical_list: D002424:Caustics
keywords: Airway management; Caustic ingestion; Emergency management; Endoscopic management; Intoxication