PULMONARY ASPIRATION DURING EMERGENCY ENDOSCOPY IN PATIENTS WITH UPPER GASTROINTESTINAL HEMORRHAGE

Objective: To evaluate the frequency and significance of aspiration and its clinical importance in patients with upper GI bleeding undergoing esophagogastroduodenoscopy in the ICU. Design: Thirty consecutive patients with active and severe upper GI bleeding were studied. Setting: ICU. Patients: Ranged in age from 20 to 78 yr with an equal number of males and females. Interventions: All patients had continuous pulse oximetry monitoring and had chest radiographs obtained < 12 hr before endoscopy and < 4 hr after endoscopy. Measurements: Six (20%) of 30 patients developed new lung infiltrates after esophagogastroduodenoscopy. In this group of patients, preendoscopy chest radiographs were obtained after < 4 hr. In five of these patients, infiltrates were accompanied by fever and/or leukocytosis and oxygen desaturation to < 90% during the esophagogastroduodenoscopy. Conclusion: Clinically significant aspiration pneumonia frequently complicates esophagogastroduodenoscopy in upper GI bleeding patients and is an important mechanism of esophagogstroduodenoscopy-induced hypoxia.