Prophylactic Endotracheal Intubation Prior to Urgent Endoscopy in Patients with Suspected Variceal Hemorrhage: An Evaluation of Outcomes and Complications
Abstract
AIM: There is limited evidence that suggests prophylactic intubation improves patient outcomes despite wide utilization. Our study aims to evaluate outcomes and complications related to prophylactic intubation through a retrospective comparison.
MATERIALS AND METHODS: Urgent esophagogastroduodenoscopy (EGD) for suspected variceal hemorrhage were included in the study and categorized into two cohorts, one with prophylactic intubation and one without. Primary outcomes for the study were immediate aspiration, post EGD pneumonia, death, and other complications. Secondary outcomes included post EGD intensive care unit (ICU) stay, total ICU stay and total hospital stay. Retrospective comparison between cohorts was performed.
RESULTS: Total 110 occurrences of urgent EGD were included. Prophylactic intubation was performed in 65 occurrence. Demographics, clinical background and significant comorbidities were similar in both cohorts. Immediate aspiration, post EGD pneumonia, and mortality were similar in both cohorts. Complications other than cardiac and pulmonary related were higher in prophylactic intubation group than no intubation group (40% vs 17.78%, P = 0.02). Overall average hospital stay of both cohorts and overall average ICU stay were similar. Average ICU stay post EGD was significant longer in prophylactic intubation group than no intubation group (4.7 ± 3.9 days vs 2.6 ± 2.6 days, P = 0.002).
CONCLUSION: Our study revealed that prophylactic intubation prior to urgent EGD for variceal hemorrhage (VH) did not improve clinical outcomes. Our finding would suggest against routine prophylactic intubation in patients having VH with only mild encephalopathy and no ongoing hemorrhage.
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References
Gines P, Quintero E, Arroyo V, Teres J, Bruguera M, Rimola A, et al. Compensated cirrhosis: natural history and prognostic factors. Hepatology. 1987;7(1):122-8.
http://onlinelibrary.wiley.com/doi/10.1002/hep.1840070124/abstract?systemMessage=WOL+Usage+report+download+page+will+be+unavailable+on+Friday+27th+January+2017+at+23%3A00+GMT%2F+18%3A00+EST%2F+07%3A00+SGT+%28Saturday+28th+Jan+for+SGT%29++for+up+to+2+hours+due+to+essential+server+maintenance.+Apologies+for+the+inconvenience.
Augustin S, Muntaner L, Altamirano JT, Gonzalez A, Saperas E, Dot J, et al. Predicting early mortality after acute variceal hemorrhage based on classification and regression tree analysis. Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association. 2009;7(12):1347-54.
http://www.sciencedirect.com/science/article/pii/S1542356509007733
Hwang JH, Shergill AK, Acosta RD, Chandrasekhara V, Chathadi KV, Decker GA, et al. The role of endoscopy in the management of variceal hemorrhage. Gastrointestinal endoscopy. 2014;80(2):221-7.
http://www.sciencedirect.com/science/article/pii/S0016510713021391
Katon RM. Complications of upper gastrointestinal endoscopy in the gastrointestinal bleeder. Digestive diseases and sciences. 1981;26(7 Suppl):47S-54S.
https://www.ncbi.nlm.nih.gov/pubmed/?term=Complications+of+upper+gastrointestinal+endoscopy+in+the+gastrointestinal+bleeder.+Digestive+diseases+and+sciences
Koch DG, Arguedas MR, Fallon MB. Risk of aspiration pneumonia in suspected variceal hemorrhage: the value of prophylactic endotracheal intubation prior to endoscopy. Digestive diseases and sciences. 2007;52(9):2225-8.
http://link.springer.com/article/10.1007%2Fs10620-006-9616-0
Rudolph SJ, Landsverk BK, Freeman ML. Endotracheal intubation for airway protection during endoscopy for severe upper GI hemorrhage. Gastrointestinal endoscopy. 2003;57(1):58-61.
http://www.sciencedirect.com/science/article/pii/S0016510703701151
Waye JD. Intubation and sedation in patients who have emergency upper GI endoscopy for GI bleeding. Gastrointestinal endoscopy. 2000;51(6):768-71.
http://www.sciencedirect.com/science/article/pii/S0016510700701040
Lohse N, Lundstrom LH, Vestergaard TR, Risom M, Rosenstock SJ, Foss NB, et al. Anaesthesia care with and without tracheal intubation during emergency endoscopy for peptic ulcer bleeding: a population-based cohort study. British journal of anaesthesia. 2015;114(6):901-8.
https://academic.oup.com/bja/article/114/6/901/253614/Anaesthesia-care-with-and-without-tracheal
Garcia-Tsao G, Sanyal AJ, Grace ND, Carey W, Practice Guidelines Committee of the American Association for the Study of Liver D, Practice Parameters Committee of the American College of G. Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis. Hepatology. 2007;46(3):922-38.
http://www.nature.com/ajg/journal/v102/n9/full/ajg2007398a.html
Lipper B, Simon D, Cerrone F. Pulmonary aspiration during emergency endoscopy in patients with upper gastrointestinal hemorrhage. Crit Care Med. 1991;19(3):330-3.
http://wx2mz2qh4l.search.serialssolutions.com/OpenURL_local?sid=Entrez:PubMed&id=pmid:1999093
Thibodeau LG, Verdile VP, Bartfield JM. Incidence of aspiration after urgent intubation. Am J Emerg Med. 1997;15(6):562-5.
http://www.sciencedirect.com/science/article/pii/S0735675797901571
Rehman A, Iscimen R, Yilmaz M, Khan H, Belsher J, Gomez JF, et al. Prophylactic endotracheal intubation in critically ill patients undergoing endoscopy for upper GI hemorrhage. Gastrointestinal endoscopy. 2009;69(7):e55-9.
http://www.sciencedirect.com/science/article/pii/S0016510709004301
Davis RE, Graham DY. Endoscopic complications: the Texas experience. Gastrointestinal endoscopy. 1979;25(4):146-9.
http://www.sciencedirect.com/science/article/pii/S0016510779734055
Silvis SE, Nebel O, Rogers G, Sugawa C, Mandelstam P. Endoscopic complications. Results of the 1974 American Society for Gastrointestinal Endoscopy Survey. JAMA. 1976;235(9):928-30.
http://jamanetwork.com/journals/jama/article-abstract/344083
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