Prophylactic endotracheal intubation in the critically ill patients with upper gastrointestinal bleed: A systematic review and meta-analysis
CCCF ePoster library. Chaudhuri D. Oct 4, 2017; 198159; 102
Dipayan Chaudhuri
Dipayan Chaudhuri
Login now to access Regular content available to all registered users.

You may also access this content "anytime, anywhere" with the Free MULTILEARNING App for iOS and Android
Abstract
Rate & Comment (0)
#102



Prophylactic endotracheal intubation in the critically ill patients with upper gastrointestinal bleed: A systematic review and meta-analysis

Chaudhuri, Dipayan1; Bishay, Kirles1; Tandon, Parul1; Trivedi, Vatsal2; Kyeremanteng; Kwadwo3

1 Department of Internal Medicine, University of Ottawa, Ottawa, Canada; 2 Department of Anesthesiology, University of Ottawa, Ottawa, Canada; 3 Department of Critical Care, University of Ottawa, Ottawa, Canada


 


Introduction:
Upper gastrointestinal bleeding (UGIB) is a common presentation and in its most severe form often requires admission to the intensive care unit (ICU). There are currently no guidelines regarding the utility of prophylactic endotracheal intubation. Here we present a systematic review and meta-analysis of clinical outcomes and cost analysis of prophylactic endotracheal intubation compared to no intubation.
Methods:
EMBASE, MEDLINE, and the Cochrane Central Register of Controlled Trials were used to identify studies that compared prophylactic endotracheal intubation to no intubation in adult patients with UGIB. Data on mortality, length of stay, cardiac complications and rates of pneumonia was collected. DerSimonian-Laird random effects models were used to calculate the inverse variance-based weighted, pooled treatment effect across studies. Costs of ICU admission were calculated using a previously validated model.
Results:
7 trials (5 manuscripts and 2 abstracts) were identified including a total of 5662 patients. Prophylactic intubation conferred increased mortality compared to no intubation (odds ratio [OR], 2.59; 95% CI [1.01 - 6.64], P = 0.05; I2 = 94%). The hospital length of stay was higher in the prophylactic intubation group (mean difference [MD], 0.96 days; 95% CI [0.26 - 1.67], P = 0.007; I2 = 0). The prophylactic intubation group had significantly higher rates of pneumonia (OR, 6.58; 95% CI [4.91 - 8.81], P <0.0001; I2 = 0%). There were also significantly higher rates of cardiac complications (OR, 2.11; 95% CI [1.04 - 4.27], P = 0.04; I2 = 6%). There was a trend towards increased ICU LOS in the prophylactically intubated group, though this difference was not statistically significant. The prophylactically intubated group incurred costs of $9020 per patient (95% CI: 6962 - 10609) compared to $7510 per patient (95% CI: 6486 - 8432) in the non-intubated group.
Conclusions:
Prophylactic intubation in UGIB is associated with higher rates of pneumonia, cardiac complications, hospital length of stay and overall mortality. Furthermore, it shows a trend towards higher cost and longer ICU  stay.  
 

    This eLearning portal is powered by:
    This eLearning portal is powered by MULTIEPORTAL
Anonymous User Privacy Preferences

Strictly Necessary Cookies (Always Active)

MULTILEARNING platforms and tools hereinafter referred as “MLG SOFTWARE” are provided to you as pure educational platforms/services requiring cookies to operate. In the case of the MLG SOFTWARE, cookies are essential for the Platform to function properly for the provision of education. If these cookies are disabled, a large subset of the functionality provided by the Platform will either be unavailable or cease to work as expected. The MLG SOFTWARE do not capture non-essential activities such as menu items and listings you click on or pages viewed.


Performance Cookies

Performance cookies are used to analyse how visitors use a website in order to provide a better user experience.


Save Settings