Prophylactic endotracheal intubation in critically ill patients undergoing endoscopy for upper GI hemorrhage.
BACKGROUND
Cardiopulmonary complications are common after endoscopy for upper GI (UGI) hemorrhage in the intensive care unit (ICU).


OBJECTIVE
To evaluate the practice and outcome of elective prophylactic endotracheal intubation before endoscopy for UGI hemorrhage in the ICU.


METHODS
Retrospective, propensity-matched case-control study.


METHODS
A 24-bed medical ICU in a tertiary center.


METHODS
ICU patients who underwent endoscopy for UGI hemorrhage.


METHODS
Cardiopulmonary complications, ICU and hospital length of stay, and mortality. In a propensity analysis, patients who were intubated for airway protection before UGI endoscopy were matched by probability of intubation to controls who were not intubated before UGI endoscopy.


RESULTS
Of 307 patients, 53 underwent elective prophylactic intubation before UGI endoscopy. The probability of intubation depended on the Acute Physiology and Chronic Health Evaluation III (APACHE III) score (OR 1.4; 95% CI, 1.2-1.6), age (OR 0.97; 95% CI, 0.95-0.09), the presence of hemetemesis (OR 1.9; 95% CI, 0.8-5.1), previous lung disease (OR 2.1; 95% CI, 0.8-4.9), and the number of transfusions (OR 1.1; 95% CI, 1.0-1.1 per unit). Nonintubated matched controls were identified for all but 4 patients with active massive hemetemesis, who were excluded from matched analysis. Cumulative incidence of cardiopulmonary complications (53% vs 45%, P = .414), ICU length of stay (median 2.2 vs 1.8 days, P = .138), hospital length of stay (6.9 vs 5.9 days, P = .785), and hospital mortality (14% vs 20%, P = .366) were similar.


CONCLUSIONS
Cardiopulmonary complications are frequent after endoscopy for acute UGI bleeding in ICU patients and are largely unaffected by the practice of prophylactic intubation.
Rehman
Ahmer
A
Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA. arehman1@hfhs.org
Iscimen
Remzi
R
Yilmaz
Murat
M
Khan
Hasrat
H
Belsher
Jon
J
Gomez
Javier Fernandez
JF
Hanson
Andrew C
AC
Afessa
Bekele
B
Baron
Todd H
TH
Gajic
Ognjen
O
D000368:Aged; D016022:Case-Control Studies; D016638:Critical Illness; D016145:Endoscopy, Digestive System / Q000009:adverse effects*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000150:complications / Q000628:therapy*; D006331:Heart Diseases / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D007362:Intensive Care Units; D007442:Intubation, Intratracheal; D008171:Lung Diseases / Q000209:etiology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D012189:Retrospective Studies