Risk of aspiration pneumonia in suspected variceal hemorrhage: The value of prophylactic endotracheal intubation prior to endoscopy

David G. Koch, Miguel R. Arguedas, Michael B. Fallon

Research output: Contribution to journalArticle

38 Scopus citations

Abstract

Variceal hemorrhage (VH) is a lethal complication of portal hypertension. Aspiration occurring during endoscopic intervention for acute VH is a concern; however, few data exist regarding the efficacy of prophylactic intubation to prevent aspiration pneumonia. We reviewed all endoscopic procedures for acute VH from January 1995 to December 2002; only patients with the absence of hepatic encephalopathy greater than stage II and normal chest x-ray at admission were included. The use of prophylactic intubation, postprocedure chest x-ray, and mortality were recorded. Sixty-two patients (69 bleeding episodes) were identified. Elective intubation was performed in 42 patients (47 episodes); pulmonary infiltrates developed in 7 of 42 (17%), with an overall mortality rate of 9 of 42 (21%). Twenty patients (22 episodes) were not intubated. None developed pulmonary infiltrates, and the overall mortality rate was 1 in 20 (5%). We conclude that in patients with suspected variceal bleeding, elective intubation is associated with a substantial risk of aspiration pneumonia.

Original languageEnglish (US)
Pages (from-to)2225-2228
Number of pages4
JournalDigestive diseases and sciences
Volume52
Issue number9
DOIs
StatePublished - Sep 1 2007
Externally publishedYes

Keywords

  • Aspiration pneumonia
  • Endoscopy
  • Endotracheal intubation
  • Esophageal varices
  • Gastrointestinal hemorrhage
  • Hepatic encephalopathy

ASJC Scopus subject areas

  • Physiology
  • Gastroenterology

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