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. 2020 Dec 10;28(1):116.
doi: 10.1186/s13049-020-00814-w.

Endotracheal intubation to reduce aspiration events in acutely comatose patients: a systematic review

Daniele Orso  1 , Luigi Vetrugno  2   3 , Nicola Federici  1 , Natascia D'Andrea  1 , Tiziana Bove  1   4
Affiliations

Endotracheal intubation to reduce aspiration events in acutely comatose patients: a systematic review

Daniele Orso et al. Scand J Trauma Resusc Emerg Med. .

Abstract

Background: It is customary to believe that a patient with a Glasgow Coma Scale (GCS) score less than or equal to 8 should be intubated to avoid aspiration. We conducted a systematic review to establish if patients with GCS ≤ 8 for trauma or non-traumatic emergencies and treated in the acute care setting (e.g., Emergency Department or Pre-hospital environment) should be intubated to avoid aspiration or aspiration pneumonia/pneumonitis, and consequently, reduce mortality.

Methods: We searched six databases, Pubmed, Embase, Scopus, SpringerLink, Cochrane Library, and Ovid Emcare, from April 15th to October 14th, 2020, for studies involving low GCS score patients of whom the risk of aspiration and related complications was assessed.

Results: Thirteen studies were included in the final analysis (7 on non-traumatic population, 4 on trauma population, 1 pediatric and 1 adult mixed case studies). For the non-traumatic cases, two prospective studies and one retrospective study found no difference in aspiration risk between intubated and non-intubated patients. Two retrospective studies reported a reduction in the risk of aspiration in the intubated patient group. For traumatic cases, the study that considered the risk of aspiration did not show any differences between the two groups. A study on adult mixed cases found no difference in the incidence of aspiration among intubated and non-intubated patients. A study on pediatric patients found increased mortality for intubated versus non-intubated non-traumatic patients with a low GCS score.

Conclusion: Whether intubation results in a reduction in the incidence of aspiration events and whether these are more frequent in patients with low GCS scores are not yet established. The paucity of evidence on this topic makes clinical trials justifiable and necessary.

Trial registration: Prospero registration number: CRD42020136987 .

Keywords: Acute care; Aspiration; Glasgow coma scale; Intubation; Outcome.

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Conflict of interest statement

Nothing to declare for all authors.

Figures

Fig. 1
Fig. 1
Flow diagram of literature search and study selection
See this image and copyright information in PMC

References

    1. ATLS Subcommittee; American College of Surgeons’ Committee on Trauma; International ATLS working group Advanced trauma life support (ATLS®): the ninth edition. J Trauma Acute Care Surg. 2013;74:1363–1366. - PubMed
    1. Marik PE. Aspiration pneumonitis and aspiration pneumonia. N Engl J Med. 2001;344:665–671. doi: 10.1056/NEJM200103013440908. - DOI - PubMed
    1. Mandell LA, Niederman MS. Aspiration pneumonia. N Engl J Med. 2019;380:651–663. doi: 10.1056/NEJMra1714562. - DOI - PubMed
    1. Sohn CH, Huh JW, Seo DW, Oh BJ, Lim KS, Kim WY. Aspiration pneumonia in carbon monoxide poisoning patients with loss of consciousness: prevalence, outcomes, and risk factors. Am J Med. 2017;130:1465.e21–1465.e26. doi: 10.1016/j.amjmed.2017.06.038. - DOI - PubMed
    1. Fawcett VJ, Warner KJ, Cuschieri J, Copass M, Grabinsky A, Kwok H, et al. Pre-hospital aspiration is associated with increased pulmonary complications. Surg Infect. 2015;16:159–164. doi: 10.1089/sur.2013.237. - DOI - PubMed

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