Prophylactic endotracheal intubation ‘should not be performed’ for upper GI bleeding
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CHARLOTTE, N.C. — Prophylactic endotracheal intubation prior to endoscopy was not beneficial for patients with upper gastrointestinal bleeding and was instead tied to adverse risks, researchers reported at ACG 2022 Annual Scientific Meeting.
“Many gastroenterologists commonly ask the ICU team to prophylactically intubate their patients with [upper GI bleeding (UGIB)] prior to endoscopy,” Syed Bilal Pasha, MD, a gastroenterology fellow at the University of Missouri School of Medicine, told Healio. “However, based on our results, prophylactic endotracheal intubation should not be performed in patients with UGIB prior to endoscopy due to increased risk of pneumonia and prolongation of the hospital stay.”
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Prophylactic endotracheal intubation for patients with upper GI bleeding prior to endoscopy is common, according to Pasha.
“The rationale given for this practice is prevention of aspiration of gastric contents,” he said. “However, the results of studies that have evaluated this practice were mixed. With this in mind, we decided to perform this meta-analysis.”
Pasha and colleagues searched databases for studies that compared prophylactic endotracheal intubation before endoscopy with no prophylactic intubation among patients with upper GI bleeding. Analysis included assessment for patient pneumonia within 48 hours, mortality, aspiration and length of hospital stay.
Researchers identified eight studies that included 5,769 patients. Those in the prophylactic endotracheal intubation group experienced a higher likelihood of pneumonia within 48 hours (OR = 6.05; 95% CI, 4.01-9.14) and had longer hospital stays (mean difference = 0.84 days; 95% CI, 0.12-1.56) compared with patients who were not intubated before the procedure. Investigators found no significant differences between the groups regarding mortality (OR = 1.43; 95% CI, 0.58-3.51) and aspiration (OR = 1.16; 95 CI, 0.48-2.77).
“The practice of intubating a patient prior to endoscopy for UGIB should not be performed prophylactically,” Pasha said. “Endotracheal intubation in these patients may be done if an indication is observed, such as respiratory compromise or inadequate mental status.”
He added, “Further randomized controlled trials on this subject would be beneficial.”
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Pasha SB, et al. Abstract S647: Should Prophylactic Endotracheal Intubation Be Performed in Upper GI Bleeding? Presented at: ACG Annual Scientific Meeting; Oct. 21-26, 2022; Charlotte, N.C. (hybrid).
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