Original articleClinical endoscopyProphylactic endotracheal intubation in critically ill patients undergoing endoscopy for upper GI hemorrhage
Section snippets
Patients and methods
We reviewed the medical records of patients who were admitted for UGI hemorrhage to our 24-bed medical ICU at the Mayo Clinic, Rochester, Minnesota, from March 2002 to August 2006. All patients received sedation during UGI endoscopy, regardless of the extent of the endoscopic examination. The institutional review board approved the study protocol. Inclusion criteria included the presence of known cirrhosis, hemetemesis, or shock. Patients were excluded if they refused research authorization,
Results
We retrospectively identified 489 patients who had an admitting diagnosis of GI hemorrhage and who underwent a UGI endoscopy, of whom 182 were excluded (Fig. 1) because they did not meet inclusion criteria (161 patients without shock, cirrhosis, or hemetemesis), were intubated for other reasons (n = 10), denied research authorization (n = 2), or fulfilled other exclusion criteria (n = 9 patients intubated before interhospital transfer). The cumulative incidence of cardiopulmonary complications
Discussion
We observed variation in the practice of prophylactic intubation for airway protection before UGI endoscopy in patients with cirrhosis, shock, and/or hemetemesis. The probability of intubation depended on age, illness severity, the number of transfusions, and the presence or absence of preexisting lung disease. In a matched-propensity analysis, the cumulative incidence of cardiopulmonary complications did not differ significantly between patients who were or were not intubated for airway
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The Acute Upper Gastrointestinal Bleed
2018, Surgical Clinics of North AmericaCitation Excerpt :Mental status changes due to shock may lead to patient inability to protect their own airway. Pragmatic consideration must be given to whether airway protection is required before the initiation of procedures such as endoscopy, but there is a lack of evidence that prophylactic intubation before endoscopy decreases complications.12 Circulation is an issue in all acute GI bleeds.
Association of prophylactic endotracheal intubation in critically ill patients with upper GI bleeding and cardiopulmonary unplanned events
2017, Gastrointestinal EndoscopyCitation Excerpt :In this study we used a propensity matching technique to overcome the potential for selection bias that can result because of a highly diverse patient population. A similar study evaluating the impact of PEI on 307 patients in which the final analysis was done on a matched cohort of only 49 patients in intubated and nonintubated groups showed that higher severity of illness scores, those presenting with hematemesis or requiring major blood transfusions, and a prior history of pulmonary disease were all factors associated with the likelihood of being intubated for airway protection before endoscopy for UGIB.15 Before the propensity-matched analysis, patients with brisk UGIB who were prophylactically intubated at our institution were younger but sicker as evident by higher Model of End-Stage Liver Disease, APACHE, AIMS65, and Rockall scores and a more common use of vasopressor agents before intubation.
Critical Care Management of Patients With Liver Disease
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DISCLOSURE: All authors disclosed no financial relationships relevant to this publication. This work was supported in part by NIH grant K23 HL78743-01A1.
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