Journal of The Korean Society of Clinical Toxicology (대한임상독성학회지)

Korean society of Clincal Toxicology (대한임상독성학회)
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Risk Factors for Aspiration Pneumonia in Acute Benzodiazepine Overdose

벤조디아제핀 급성 중독에서 발생하는 흡인성 폐렴 위험 인자

  • Chung, Won Sik (Department of Emergency Medicine, Medical School, The Catholic University of Korea) ;
  • Cha, Kyung Man (Department of Emergency Medicine, Medical School, The Catholic University of Korea) ;
  • Kim, Hyung Min (Department of Emergency Medicine, Medical School, The Catholic University of Korea) ;
  • Jeong, Won Jung (Department of Emergency Medicine, Medical School, The Catholic University of Korea) ;
  • So, Byung Hak (Department of Emergency Medicine, Medical School, The Catholic University of Korea)
  • 정원식 (가톨릭대학교 의과대학 응급의학교실) ;
  • 차경만 (가톨릭대학교 의과대학 응급의학교실) ;
  • 김형민 (가톨릭대학교 의과대학 응급의학교실) ;
  • 정원중 (가톨릭대학교 의과대학 응급의학교실) ;
  • 소병학 (가톨릭대학교 의과대학 응급의학교실)
  • Received : 2016.05.16
  • Accepted : 2016.05.27
  • Published : 2016.06.30
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Abstract

Purpose: Aspiration pneumonia is an important complication of drug intoxication with decreased mental status. The purpose of the study is to investigate the risk factors of aspiration pneumonia in the patients of benzodiazepine overdose with or without co-ingestion of other drugs. Methods: A retrospective chart review of patients who visited the emergency department between January 2012 and December 2014 was conducted. Demographic data, time from ingestion to visit, initial vital signs, symptoms, mental status, medical history, laboratory results, chest radiological findings and co-ingested medications were recorded. Multiple logistic analyses were performed to verify the association between variables and the development of aspiration pneumonia. Results: A total of 249 patients presented to the emergency department with benzodiazepine overdose. Aspiration pneumonia had developed in 24 patients (9.6%). Univariate analysis revealed time from ingestion to visit was longer, Glasgow coma scale score was lower, hypoxia was presented, leukocytosis was shown, types of ingested drugs was high, less activated charcoal was applied and tricyclic antidepressants was taken in patients that developed aspiration pneumonia. Time from ingestion to visit (odds ratio (OR) 1.121, 95% confidence interval (CI), 1.057-1.189, p=0.000), GCS score (OR 0.724. 95% CI, 0.624-0.839, p=0.000), oxygen saturation (OR 0.895, 95% CI, 0.835-0.959, p=0.002), and co-ingestion of TCA (OR 4.595, 95% CI, 1.169-18.063, p=0.029) were identified as risk factors of morbidity of aspiration pneumonia upon multiple logistic regression analysis. Conclusion: Time from ingestion to visit, low GCS score, low oxygen saturation and co-ingestion of TCA were risk factors of the development of aspiration pneumonia in benzodiazepine overdose patients.

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References

  1. Bachhuber MA, Hennessy S, Cunningham CO, Starrels JL. Increasing Benzodiazepine Prescriptions and Overdose Mortality in the United States, 1996-2013. Am J Public Health 2016;106:686-8. https://doi.org/10.2105/AJPH.2016.303061
  2. Narstaran EM, Saghaei M, Alfred S, Zargarzadeh AH, Huynh C, Gheshlaghi F, et al. Comparative Evaluation of Glasgow Coma Score and Gag Reflex in Predicting Aspiration Pneumonitis in Acute Poisoning. J Critical Care 2009;24:470.9-15.
  3. Eddleston M. Patterns and problems of deliberate self-poisoning in the developing world. QJM 2000;93:715-31. https://doi.org/10.1093/qjmed/93.11.715
  4. Christ A1, Arranto CA, Schindler C, Klima T, Hunziker PR, Siegemund M, et al. Incidence, risk factors, and outcome of aspiration pneumonitis in ICU overdose patients. Intensive Care Med 2006;32:1423-7. https://doi.org/10.1007/s00134-006-0277-4
  5. Isbister GK, Downes F, Sibbritt D, Dawson AH, Whyte IM. Aspiration pneumonitis in an overdose population: frequency, predictors, and outcomes. Crit Care Med 2004;32:88-93. https://doi.org/10.1097/01.CCM.0000104207.42729.E4
  6. CDC.org. Atlanta: Centers for Disease Control and Prevention; c2010-15. Available from: http://www.cdc.org [cited 16 March 2004].
  7. Paul EM, M.B, B.C. Aspiration Pneumonitis and Aspiration Pneumonia. N Engl J Med 2001;344:665-71. https://doi.org/10.1056/NEJM200103013440908
  8. Adnet F, Baud F. Relation between Glasgow Coma Scale and aspiration pneumonia. Lancet 1996;348:123-4.
  9. Ghim BK, Choi SY, Kang IJ, Kang YJ, Kwon BS, Lee JE, et al. Association between nasogastric tube insertion and aspiration pneumonia in drug intoxication. J Korean Med Sci 2009;78:87-94.
  10. Roy TM, Ossorio MA, Cipolla LM, Fields CL, Snider HL, Anderson WH. Pulmonary complications after tricyclic antidepressant overdose. Chest 1989;96:852-56. https://doi.org/10.1378/chest.96.4.852
  11. Shannon M, Lovejoy FH Jr. Pulmonary consequences of severe tricyclic antidepressant ingestion. J Toxicol Clin Toxicol 1987;25:443-61. https://doi.org/10.3109/15563658708992648
  12. Varnell RM, Godwin JD, Richardson ML, Vincent JM. Adult respiratory distress syndrome from overdose of tricyclic antidepressants. Radiology 1989; 170:667-70. https://doi.org/10.1148/radiology.170.3.2916020
  13. Terpenning MS, Taylor GW, Lopatin DE, Kerr CK, Dominguez BL, Loesche WJ. Aspiration pneumonia: dental and oral risk factors in an older veteran population. J Am Geriatr Soc 2001;49:557-63. https://doi.org/10.1046/j.1532-5415.2001.49113.x
  14. Kim DH, Oh JS, Kyoung YY, Choi SM, Oh YM, Choi KH, et al. Evaluation of the Risk Factors for Aspiration Pneumonitis Following Drug Intoxication. J Korean Soc Clin Toxicol 2009;7:127-36.
  15. Kang MJ, Lim JY, Oh SH, Kim HJ, Kim YM. Factors associated with Occurrence of Aspiration Pneumonia in the Patient with Sedative-hypnotics Acute Overdoes. J Korean Soc Clin Toxicol 2015;13:95-102.