Prophylactic endotracheal intubation in critically ill patients undergoing endoscopy for upper GI hemorrhage - 23/08/11
Reprint requests: Ognjen Gajic, MD, MSc, Mayo Clinic, 200 First Street SW, Rochester, MN 55905.Rochester, Minnesota, USA, Bursa, Antalya, Turkey
Abstract |
Background |
Cardiopulmonary complications are common after endoscopy for upper GI (UGI) hemorrhage in the intensive care unit (ICU).
Objective |
To evaluate the practice and outcome of elective prophylactic endotracheal intubation before endoscopy for UGI hemorrhage in the ICU.
Design |
Retrospective, propensity-matched case-control study.
Setting |
A 24-bed medical ICU in a tertiary center.
Patients |
ICU patients who underwent endoscopy for UGI hemorrhage.
Main Outcome Measurements |
Cardiopulmonary complications, ICU and hospital length of stay, and mortality. In a propensity analysis, patients who were intubated for airway protection before UGI endoscopy were matched by probability of intubation to controls who were not intubated before UGI endoscopy.
Results |
Of 307 patients, 53 underwent elective prophylactic intubation before UGI endoscopy. The probability of intubation depended on the Acute Physiology and Chronic Health Evaluation III (APACHE III) score (OR 1.4; 95% CI, 1.2-1.6), age (OR 0.97; 95% CI, 0.95-0.09), the presence of hemetemesis (OR 1.9; 95% CI, 0.8-5.1), previous lung disease (OR 2.1; 95% CI, 0.8-4.9), and the number of transfusions (OR 1.1; 95% CI, 1.0-1.1 per unit). Nonintubated matched controls were identified for all but 4 patients with active massive hemetemesis, who were excluded from matched analysis. Cumulative incidence of cardiopulmonary complications (53% vs 45%, P = .414), ICU length of stay (median 2.2 vs 1.8 days, P = .138), hospital length of stay (6.9 vs 5.9 days, P = .785), and hospital mortality (14% vs 20%, P = .366) were similar.
Conclusions |
Cardiopulmonary complications are frequent after endoscopy for acute UGI bleeding in ICU patients and are largely unaffected by the practice of prophylactic intubation.
Le texte complet de cet article est disponible en PDF.Abbreviations : APACHE III, ICU, UGI
Plan
| 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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| If you want to chat with an author of this article, you may contact him at arehman1@hfhs.org. |
Vol 69 - N° 7
P. e55-e59 - juin 2009 Retour au numéro
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