Prophylactic tracheal intubation for upper GI bleeding: A meta-analysis.
OBJECTIVE
To evaluate usefulness of prophylactically intubating upper gastrointestinal bleeding (UGIB) patients.


METHODS
UGIB results in a significant number of hospital admissions annually with endoscopy being the key intervention. In these patients, risks are associated with the bleeding and the procedure, including pulmonary aspiration. However, very little literature is available assessing the use of prophylactic endotracheal intubation on aspiration in these patients. A comprehensive search was performed in May 2014 in Scopus, CINAHL, Cochrane databases, PubMed/Medline, Embase, and published abstracts from national gastroenterology meetings in the United States (2004-2014). Included studies examined UGIB patients and compared prophylactic intubation to no intubation before endoscopy. Meta-analysis was conducted using RevMan 5.2 by Mantel-Haenszel and DerSimonian and Laird models with results presented as odds ratio for aspiration, pneumonia (within 48 h), and mortality. Funnel plots were utilized for publication bias andI2measure of inconsistency for heterogeneity assessments.


RESULTS
Initial search identified 571 articles. Of these articles, 10 relevant peer-reviewed articles in English and two relevant abstracts were selected to review by two independent authors (Almashhrawi AA and Bechtold ML). Of these studies, eight were excluded: Five did not have a control arm, one was a letter the editor, one was a survey study, and one was focused on prevention of UGIB. Therefore, four studies (N= 367) were included. Of the UGIB patients prophylactically intubated before endoscopy, pneumonia (within 48 h) was identified in 20 of 134 (14.9%) patients as compared to 5 of 95 (5.3%) patients that were not intubated prophylactically (P= 0.02). Despite observed trends, no significant differences were found for mortality (P= 0.18) or aspiration (P= 0.11).


CONCLUSIONS
Pneumonia within 48 h is more likely in UGIB patients who received prophylactic endotracheal intubation prior to endoscopy.
Division of Gastroenterology and Hepatology, University of Missouri, Columbia, MO 65212, United States.
Ashraf A
AA
Almashhrawi
Division of Gastroenterology and Hepatology, University of Missouri, Columbia, MO 65212, United States.
Rubayat
R
Rahman
Division of Gastroenterology and Hepatology, University of Missouri, Columbia, MO 65212, United States.
Samuel T
ST
Jersak
Division of Gastroenterology and Hepatology, University of Missouri, Columbia, MO 65212, United States.
Akwi W
AW
Asombang
Division of Gastroenterology and Hepatology, University of Missouri, Columbia, MO 65212, United States.
Alisha M
AM
Hinds
Division of Gastroenterology and Hepatology, University of Missouri, Columbia, MO 65212, United States.
Hazem T
HT
Hammad
Division of Gastroenterology and Hepatology, University of California, Irvine, CA 92697, United States.
Douglas L
DL
Nguyen
Division of Gastroenterology and Hepatology, University of Missouri, Columbia, MO 65212, United States.
Matthew L
ML
Bechtold
Aspiration; Complication; Endoscopy; Pneumonia; Prophylactic endotracheal intubation; Upper gastrointestinal bleeding