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THE INCIDENCE OF PULMONARY ASPIRATION SYNDROME IN PATIENTS WITH SMALL BOWEL OBSTRUCTION - A RETROSPECTIVE STUDY
Jacqueline Hawthorne*1, Jonathan S. Gani1,2
1Surgery, Hunter New England Health, New Lambton Heights, New South Wales, Australia; 2Department of Surgery, University of Newcastle, Newcastle, New South Wales, Australia
Background
The regurgitation and aspiration of gastrointestinal fluid is a complication of small bowel obstruction (SBO) which is under reported and is potentially lethal. The aim of this study was to investigate the incidence of Pulmonary Aspiration Syndrome (PAS) in a cohort of patients with SBO managed at a major teaching hospital over a six month period by retrospective audit. The influence of nasogastric (NG) tube on this phenomenon was also investigated.
Method
The John Hunter Hospital is a tertiary referral hospital in NSW. We reviewed patients admitted between 1st January to 30th June 2016 over the age of 18 with a diagnosis of SBO. We reviewed the progress of these patients using the hospitals electronic medical records and then divided the patients into groups based on their outcome. This incidence of PAS was identified and the context of this complication defined.
Results
84 patients were identified in this audit, the in hospital mortality rate was 10.7%. The rate of PAS was 4.8%; half of these patients who aspirated died during their admission. 62% of patients with SBO had a NG tube as part of their management. There was no statistically significant difference in PAS between those patients who had NG tube and those who did not (5.6% vs 3.3%). Continuous suction on the NG tube did not prevent PAS. 77.8% of patients who died during admission were aged over 80 years.
Conclusion and Clinical Relevance
SBO is a common condition presenting to emergency departments. Current recommendations state patients with SBO should be treated with NG intubation; however the results of our study suggest that this does not prevent PAS (even if the NG tube is on suction). PAS has a high mortality rate (50%), although this is age dependent. This needs to be considered in the decision to pass an NG tube.
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