Should We Intubate the Patient First? Outcomes of Prophylactic Endotracheal Intubation for Upper Gastrointestinal Bleeding

Abdulsamad, Molham; Kamireddy, Chandana; Karki, Niraj; Sakam, Sailaja; Kumar, Kishore; Ebiem, Okechukwu; Ihimoyan, Ariyo

doi:10.14309/00000434-201610001-02527

Cited by 3 publications

(13 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…While most studies showed a trend toward increased mortality, 7,8,[16][17][18][19][20] none showed a statistically significant increase in mortality between groups. Although there was significant heterogeneity among studies, prophylactic intubation showed increased mortality compared to no intubation.…”

Section: Discussionmentioning

confidence: 87%

“…Figure 1 illustrates our study flow diagram. The studies of Abdulsamad et al 16 . Five studies were full-length manuscripts, 7,8,[17][18][19] and two were abstracts.…”

Section: Resultsmentioning

confidence: 98%

“…7,8,[16][17][18][19][20] The coefficient of agreement between reviewers was 0.85 (95% confidence interval [CI]: 0.71-0.98). The initial literature search resulted in 980 articles (301 from MEDLINE, 633 from EMBASE, and 37 from Cochrane [central]), of which 699 nonduplicate articles were selected for abstract review.…”

Section: Resultsmentioning

confidence: 99%

“…Fourteen abstracts were selected for manuscript evaluation. 16,20 All studies were retrospective. 7,8,[16][17][18][19][20] The coefficient of agreement between reviewers was 0.85 (95% confidence interval [CI]: 0.71-0.98).…”

Section: Resultsmentioning

confidence: 99%

“…7,8,[16][17][18][19][20] The coefficient of agreement between reviewers was 0.85 (95% confidence interval [CI]: 0.71-0.98). 16,19,20 Lohse et al 19 had significantly different baseline characteristics between their two groups. The included studies were published from 2006 to 2017.…”

Section: Resultsmentioning

confidence: 99%

See 4 more Smart Citations

Prophylactic endotracheal intubation in critically ill patients with upper gastrointestinal bleed: A systematic review and meta‐analysis

et al. 2019

View full text Add to dashboard Cite

Background and Aim Prophylactic endotracheal intubation for airway protection prior to endoscopy for the management of severe upper gastrointestinal bleeding (UGIB) is controversial. The aim of this meta‐analysis is to examine the clinical outcomes and costs related to prophylactic endotracheal intubation compared to no intubation in UGIB. Methods EMBASE, MEDLINE, and the Cochrane Central Register of Controlled Trials were used to identify studies through June 2017. Data regarding mortality, total hospital and intensive care unit length of stay (LOS), pneumonia, and cardiovascular events were collected. The DerSimonian‐Laird random effects models were used to calculate the inverse variance‐based weighted, pooled treatment effect across studies. Results Seven studies (five manuscripts and two abstracts) were identified (5662 total patients). Prophylactic intubation conferred an increased risk of death (odds ratio [OR], 2.59, 95% confidence interval [CI]: 1.01–6.64), hospital LOS (mean difference, 0.96 days, 95% CI: 0.26–1.67), and pneumonia (OR 6.58, 95% CI: 4.91–8.81]) compared to endoscopy without intubation. The LOS‐related cost was greater when prophylactic intubation was performed ($9020 per patient, 95% CI: $6962–10 609) compared to when it was not performed ($7510 per patient, 95% CI: $6486–8432). There was no difference in risk of cardiovascular events after sensitivity analysis. Conclusion Prophylactic intubation in severe UGIB is associated with a greater risk of pneumonia, LOS, death, and cost compared to endoscopy without intubation. Randomized trials examining this issue are warranted.

show abstract

Section: Discussionmentioning

confidence: 87%

“…Figure 1 illustrates our study flow diagram. The studies of Abdulsamad et al 16 . Five studies were full-length manuscripts, 7,8,[17][18][19] and two were abstracts.…”

Section: Resultsmentioning

confidence: 98%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

Prophylactic endotracheal intubation in critically ill patients with upper gastrointestinal bleed: A systematic review and meta‐analysis

et al. 2019

View full text Add to dashboard Cite

show abstract

Prophylactic endotracheal intubation in patients with upper gastrointestinal bleeding undergoing endoscopy: A systematic review and meta-analysis

Alshamsi

Jaeschke

Baw

et al. 2017

Saudi J Med Med Sci

View full text Add to dashboard Cite

Background:Patients with upper gastrointestinal bleeding (UGIB) often require urgent or emergent esophagogastroduodenoscopy (EGD) and are at risk of complications such as aspiration of gastric content or blood. The role of prophylactic endotracheal intubation (PEI) in the absence of usual respiratory status-related indications is not well established.Methods:We searched Medline, EMBASE, Cochrane Library's Central Register of Controlled Trials (CENTRAL) and SCOPUS from inception through July 2017 without date or language of publication restriction. We included studies that compared PEI with usual care (UC) in patients with acute UGIB, and reported any of the following outcomes: aspiration, pneumonia, mortality and length of stay. We excluded studies in which majority of included patients required intubation due to respiratory failure or decreased level of consciousness. We used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to assess the quality of evidence for each outcome.Results:We did not identify any randomized trials on this topic. We included 10 observational studies (n = 6068). We were not able to perform any adjusted analyses. PEI was associated with a significant increase in aspiration (OR 3.85, 95% CI, 1.46, 10.25; P = 0.01; I2= 56%; low-quality evidence), pneumonia (OR 4.17, 95% CI, 1.82, 9.57; P = 0.0007; I2=52%; low-quality evidence) and hospital length of stay (mean difference 0.86 days, 95% CI 0.13, 1.59; P = 0.02; I2= 0; low-quality evidence), without clear effect on mortality (OR 1.92, 95% CI, 0.71, 5.23; P = 0.2; I2= 95%; very low-quality evidence).Conclusions:Low- to very low-quality evidence from observational studies suggests that PEI in the setting of UGIB may be associated with higher rates of respiratory complications and, less likely, with increased mortality. Although the results are alarming, the lack of higher quality evidence calls for randomized trials to inform practice.

show abstract

Should Prophylactic Endotracheal Intubation Be Performed in Upper Gastrointestinal Bleeding?

Pasha,

Tarar,

Chela

et al. 2024

Cureus

View full text Add to dashboard Cite

No consensus exists on the standard of intraoperative airway management approach to prevent endoscopy complications in acute gastrointestinal (GI) bleeding. Eight years after our initial meta-analysis, we reassessed the effect of prophylactic endotracheal intubation in acute GI bleeding in hospitalized patients. Multiple databases were reviewed in 2024, identifying 10 studies that compared prophylactic endotracheal intubation (PEI) versus no intubation in acute upper GI bleeding in hospitalized patients. Outcomes of interest included pneumonia, length of hospital stay, aspiration, and mortality. The odds ratio (OR) or mean difference (MD) using the random effects model was calculated for each outcome. In total, 11 studies (10 retrospective, one prospective) were included in the meta-analysis (n = 7,332). PEI demonstrated statistically significant higher odds of pneumonia (OR = 5.83; 95% confidence interval (CI) = 3.15-10.79; p < 0.01) and longer length of stays (MD = 0.84; 95% CI = 0.12-1.56; p = 0.02). However, mortality (OR = 1.68; 95% CI = 0.78-3.64; p = 0.19) and aspiration (OR = 2.79; 95% CI = 0.89-8.7; p = 0.08) were not statistically significant. PEI before esophagogastroduodenoscopy for hospitalized upper GI bleeding patients is associated with an increased incidence of pneumonia within 48 hours and prolonged hospitalization but no statistically significant increased risk of mortality or aspiration.

show abstract

Should We Intubate the Patient First? Outcomes of Prophylactic Endotracheal Intubation for Upper Gastrointestinal Bleeding

Cited by 3 publications

References 0 publications

Prophylactic endotracheal intubation in critically ill patients with upper gastrointestinal bleed: A systematic review and meta‐analysis

Prophylactic endotracheal intubation in critically ill patients with upper gastrointestinal bleed: A systematic review and meta‐analysis

Prophylactic endotracheal intubation in patients with upper gastrointestinal bleeding undergoing endoscopy: A systematic review and meta-analysis

Should Prophylactic Endotracheal Intubation Be Performed in Upper Gastrointestinal Bleeding?

Contact Info

Product

Resources

About