Cardiopulmonary complications are common after endoscopy for upper gastrointestinal (UGI) hemorrhage in the intensive care unit (ICU)
To evaluate the practice and outcome of elective prophylactic endotracheal intubation prior to endoscopy for UGI hemorrhage in the ICU
Retrospective, propensity matched case-control study
A 24-bed medical ICU in a tertiary center.
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 prior to UGI endoscopy were matched by probability of intubation to controls not intubated prior to UGI endoscopy.
Fifty-three out of 307 patients underwent elective prophylactic intubation prior to UGI endoscopy. Probability of intubation depended on APACHE III score (OR 1.4, 95%, CI 1.2 to 1.6), age (OR 0.97, 95%CI 0.95 to 0.09), presence of hematemesis (OR 1.9, 95%CI 0.8 to 5.1), prior lung disease (OR 2.1, 95%CI 0.8 to 4.9) and number of transfusions (OR 1.1 95%CI 1.0 to 1.1 per unit). Non-intubated matched controls were identified for all but 4 patients with active massive hematemesis who were excluded from matched analysis. Cumulative incidence of cardiopulmonary complications (53% vs 45%, p=0.414), ICU (median 2.2 days vs. 1.8 days, p=0.138) and hospital length of stay (6.9 vs. 5.9, p=0.785), and hospital mortality (14% vs. 20%, p=0.366) were similar.
Cardiopulmonary complications are frequent after endoscopy for acute UGI bleeding in ICU patients, and are largely unaffected by the practice of prophylactic intubation.