title: Prophylactic endotracheal intubation in critically ill patients undergoing endoscopy for upper GI hemorrhage.
abstract: 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.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA. arehman1@hfhs.org
authors.forename: Ahmer
authors.initials: A
authors.lastname: Rehman
authors.forename: Remzi
authors.initials: R
authors.lastname: Iscimen
authors.forename: Murat
authors.initials: M
authors.lastname: Yilmaz
authors.forename: Hasrat
authors.initials: H
authors.lastname: Khan
authors.forename: Jon
authors.initials: J
authors.lastname: Belsher
authors.forename: Javier Fernandez
authors.initials: JF
authors.lastname: Gomez
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Hanson
authors.forename: Bekele
authors.initials: B
authors.lastname: Afessa
authors.forename: Todd H
authors.initials: TH
authors.lastname: Baron
authors.forename: Ognjen
authors.initials: O
authors.lastname: Gajic
mesh_terms: 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