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Review
. 2024 Jul 15;16(7):e64567.
doi: 10.7759/cureus.64567. eCollection 2024 Jul.

Should Prophylactic Endotracheal Intubation Be Performed in Upper Gastrointestinal Bleeding?

Syed Bilal Pasha  1 , Zahid Ijaz Tarar  2 , Harleen Chela  2 , Aidan McDermott  2 , Jocelyn Ihnat  2 , Michelle L Matteson-Kome  3 , Yezaz A Ghouri  4 , Matthew L Bechtold  5
Affiliations
Review

Should Prophylactic Endotracheal Intubation Be Performed in Upper Gastrointestinal Bleeding?

Syed Bilal Pasha et al. Cureus. .

Abstract

No consensus exists on the standard of intraoperative airway management approach to prevent endoscopy complications in acute gastrointestinal (GI) bleeding. Eight years after our initial meta-analysis, we reassessed the effect of prophylactic endotracheal intubation in acute GI bleeding in hospitalized patients. Multiple databases were reviewed in 2024, identifying 10 studies that compared prophylactic endotracheal intubation (PEI) versus no intubation in acute upper GI bleeding in hospitalized patients. Outcomes of interest included pneumonia, length of hospital stay, aspiration, and mortality. The odds ratio (OR) or mean difference (MD) using the random effects model was calculated for each outcome. In total, 11 studies (10 retrospective, one prospective) were included in the meta-analysis (n = 7,332). PEI demonstrated statistically significant higher odds of pneumonia (OR = 5.83; 95% confidence interval (CI) = 3.15-10.79; p < 0.01) and longer length of stays (MD = 0.84; 95% CI = 0.12-1.56; p = 0.02). However, mortality (OR = 1.68; 95% CI = 0.78-3.64; p = 0.19) and aspiration (OR = 2.79; 95% CI = 0.89-8.7; p = 0.08) were not statistically significant. PEI before esophagogastroduodenoscopy for hospitalized upper GI bleeding patients is associated with an increased incidence of pneumonia within 48 hours and prolonged hospitalization but no statistically significant increased risk of mortality or aspiration.

Keywords: bleeding; length of stay; meta-analysis; pneumonia; prophylactic intubation.

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Conflict of interest statement

Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: Matthew Bechtold MD declare(s) personal fees from Medtrition. Advisory Board. Matthew Bechtold MD declare(s) personal fees from Nestle Nutrition Institute. Nutrition lectures. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Literature search flowchart.
Figure 2
Figure 2. Aspiration.
Forest plot demonstrating the comparison of prophylactic intubation versus no intubation for patients with UGIB for aspiration [2,4,5,10-14]. UGIB = upper gastrointestinal bleeding; PEI = prophylactic endotracheal intubation
Figure 3
Figure 3. Pneumonia.
Forest plot demonstrating the comparison of prophylactic intubation versus no intubation for patients with UGIB for pneumonia within 48 hours [2,4,5,8,10,11,13,14]. UGIB = upper gastrointestinal bleeding; PEI = prophylactic endotracheal intubation
Figure 4
Figure 4. Mortality.
Forest plot demonstrating the comparison of prophylactic intubation versus no intubation for patients with UGIB for mortality [2-5,8-10,12-14]. UGIB = upper gastrointestinal bleeding; PEI = prophylactic endotracheal intubation
Figure 5
Figure 5. Length of hospital stay.
Forest plot demonstrating the comparison of prophylactic intubation versus no intubation for patients with UGIB for the length of hospital stay [2-5,13]. UGIB = upper gastrointestinal bleeding; PEI = prophylactic endotracheal intubation
Figure 6
Figure 6. Funnel plot.
Funnel plot showing no publication bias [2-5,8-10,12-14].
See this image and copyright information in PMC

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