We have located links that may give you full text access.
Prophylactic endotracheal intubation in critically ill patients with upper gastrointestinal bleed: A systematic review and meta-analysis.
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.
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.
Full text links
Related Resources
Trending Papers
Heart failure with preserved ejection fraction: diagnosis, risk assessment, and treatment.Clinical Research in Cardiology : Official Journal of the German Cardiac Society 2024 April 12
Proximal versus distal diuretics in congestive heart failure.Nephrology, Dialysis, Transplantation 2024 Februrary 30
Efficacy and safety of pharmacotherapy in chronic insomnia: A review of clinical guidelines and case reports.Mental Health Clinician 2023 October
World Health Organization and International Consensus Classification of eosinophilic disorders: 2024 update on diagnosis, risk stratification, and management.American Journal of Hematology 2024 March 30
Get seemless 1-tap access through your institution/university
For the best experience, use the Read mobile app
All material on this website is protected by copyright, Copyright © 1994-2024 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.
By using this service, you agree to our terms of use and privacy policy.
Your Privacy Choices
You can now claim free CME credits for this literature searchClaim now
Get seemless 1-tap access through your institution/university
For the best experience, use the Read mobile app