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Original Research: Critical Care |

Characteristics and Outcomes of Patients Hospitalized Following Pulmonary AspirationPatients Hospitalized After Pulmonary Aspiration

Augustine Lee, MD, FCCP; Emir Festic, MD; Pauline K. Park, MD; Krishnan Raghavendran, MD; Ousama Dabbagh, MD, FCCP; Adebola Adesanya, MD, FCCP; Ognjen Gajic, MD, FCCP; Raquel R. Bartz, MD, FCCP; the United States Critical Illness and Injury Trials Group
Author and Funding Information

From the Department of Critical Care Medicine and Division of Pulmonary Medicine (Drs Lee and Festic), Mayo Clinic Florida, Jacksonville, FL; Division of Acute Care Surgery (Drs Park and Raghavendran), Department of Surgery, University of Michigan, Ann Arbor, MI; Division of Pulmonary and Critical Care (Dr Dabbagh), Department of Internal Medicine, University of Missouri, Columbia, MO; Department of Anesthesiology (Dr Adesanya), Department of Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, TX; Pulmonary and Critical Care Medicine (Dr Gajic), Mayo Clinic, Rochester, MN; and Department of Anesthesiology (Dr Bartz), Duke University Medical Center, Durham, NC.

CORRESPONDENCE TO: Augustine Lee, MD, FCCP, Department of Critical Care Medicine and Division of Pulmonary Medicine, Mayo Clinic Florida, 4500 San Pablo Rd, Jacksonville, FL 32224; e-mail: lee.augustine@mayo.edu


Portions of this analysis were presented in abstract form at the 40th Critical Care Congress, January 15-19, 2011, San Diego, CA.

FUNDING/SUPPORT: This work was supported by the National Institutes of Health [HL78743-01A1, KL2 RR024151], the Mayo Clinic Critical Care Research Committee, Mayo Clinic Foundation, and the National Center for Advancing Translational Sciences (NCATS) [CTSA UL1-TR000135].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2014;146(4):899-907. doi:10.1378/chest.13-3028
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BACKGROUND:  Pulmonary aspiration is an important recognized cause of ARDS. Better characterization of patients who aspirate may allow identification of potential risks for aspiration that could be used in future studies to mitigate the occurrence of aspiration and its devastating complications.

METHODS:  We conducted a secondary analysis of the Lung Injury Prediction Score cohort to better characterize patients with aspiration, including their potential risk factors and related outcomes.

RESULTS:  Of the 5,584 subjects at risk for ARDS and who required hospitalization, 212 (3.8%) presented with aspiration. Subjects who aspirated were likely to be male (66% vs 56%, P < .007), slightly older (59 years vs 57 years), white (73% vs 61%, P = .0004), admitted from a nursing home (15% vs 5.9%, P < .0001), have a history of alcohol abuse (21% vs 8%, P < .0001), and have lower Glasgow Coma Scale (median, 13 vs 15; P < .0001). Aspiration subjects were sicker (higher APACHE [Acute Physiology and Chronic Health Evaluation] II score), required more mechanical ventilation (54% vs 32%, P < .0001), developed more moderate to severe ARDS (12% vs 3.8%, P < .0001), and were twofold more likely to die in-hospital, even after adjustment for severity of illness (OR = 2.1; 95% CI, 1.2-3.6). Neither obesity nor gastroesophageal reflux was associated with aspiration.

CONCLUSIONS:  Aspiration was more common in men with alcohol abuse history and a lower Glasgow Coma Scale who were admitted from a nursing home. It is independently associated with a significant increase in the risk for ARDS as well as morbidity and mortality. Findings from this study may facilitate the design of future clinical studies of aspiration-induced lung injury.

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