Risk Factors for Aspiration Pneumonia After Endoscopic Hemostasis

Abstract

Specific risk factors for aspiration pneumonia after endoscopic hemostasis were identified. Endoscopists should carefully consider aspiration pneumonia when managing older patients who are on hemodialysis, have a history of stroke, and undergo a longer procedure.

The Epidemiology and Risk Factors for Postoperative Pneumonia

“…Another mechanism leading to the development of postoperative pneumonia is aspiration in endoscopic hemostasis, as outlined in a retrospective study of 504 patients by Kawanishi et al [17]. They reported a postoperative aspiration pneumonia incidence of 4.8%.…”

“…Additionally, the model for end-stage liver disease (MELD) score was higher in VAP patients on univariate analysis. Kawanishi et al [17] identified age >75 years (OR: 4.4; 95% CI: 1.5 - 13.6; P = 0.0073), procedural duration > 30 min (OR: 5.6; 95% CI: 1.9 - 18.2; P = 0.0023), hemodialysis (OR: 3.6; 95% CI: 1.2 - 11; P = 0.024), and a history of stroke (OR: 3.8; 95% CI: 1 - 14; P = 0.041) as independent risk factors for developing postoperative pneumonia. Okamura et al [20] identified higher lung age (OR: 1.02; 95% CI: 1.00 - 1.03; P = 0.010) and lower body mass index (OR: 0.89; 95% CI: 0.82 - 0.96; P = 0.006) as independent risk factors.…”

Pulmonary aspiration during procedural sedation: a comprehensive systematic review

“…2). [29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44] Most of the identified instances were in adult patients who had substantial underlying illness, with propofol as the principal sedative. The eight deaths resulted from procedures performed for percutaneous endoscopic gastrostomy tube placement (n¼4), active gastrointestinal bleeding (n¼3), or endoscopic submucosal dissection (n¼1).…”

“…• Barbara and colleagues 2015: 30 A 50-yr-old ICU patient aspirated during fentanyl and midazolam facilitated endoscopy for active GI bleeding and suffered cardiac arrest; despite resuscitation he died shortly thereafter of multi-organ failure. • Kawanishi and colleagues 2016: 31 24 adults aspirated during diazepam-facilitated endoscopy for active GI bleeding; 3 were intubated and 1 died. • Park and colleagues 2013: 32 38 adults aspirated during propofol or midazolam-facilitated endoscopic submucosal dissection; 1 death.…”

Appendectomy as a Risk Factor for Bacteremic Biliary Tract Infection Caused by Antibiotic-Resistant Pathogens

“…p value < 0.05 was considered statistically significant and odds ratios (ORs) with 95% confidence intervals (CIs) were determined. Data were statistically analyzed using JMP version 9 software (SAS Institute, Cary, NC, USA) [15]. …”