Incidence of aspiration pneumonia in intubated patients receiving activated charcoal

Several case reports and animal studies raise concerns over the risk of asp iration pneumonia when administering activated charcoal (AC) to intubated p atients. Therefore, we sought to determine the incidence of aspiration pneu monia in intubated overdose patients who then received AC. We conducted a r etrospective review from January 1994 to April 1997 of intubated patients w ho then received AC, Patients were transferred to, or primarily treated at, an 843-bed tertiary medical center with an annual emergency department vol ume of 100,000 patients. Objective evidence of infiltrate on chest radiogra ph during initial 48 h of hospitalization was used to determine the inciden ce of aspiration pneumonia, Patients with known preexisting pneumonia or wi th administration of AC before intubation were excluded. There were 64 pati ents identified. Fourteen were excluded for clinical aspiration before intu bation, receiving activated charcoal before intubation, or abnormal immedia te post-intubation chest radiographs, The remaining 50 patients, ages 1-64 years, 33% male, overdosing on a large variety of substances, required acut e intubation and then received AC, Only two patients of these 50 (4%) with initial negative radiographs developed a new infiltrate after intubation an d AC, Administration of AC to intubated overdose patients is associated wit h a low incidence of aspiration pneumonia. (C) 1999 Elsevier Science Inc.