Prophylactic endotracheal intubation in critically ill patients undergoing endoscopy for upper GI hemorrhage

Ahmer Rehman, Remzi Iscimen, Murat Yilmaz, Hasrat Khan, Jon Belsher, Javier Fernandez Gomez, Andrew C. Hanson, Bekele Afessa, Todd H. Baron, Ognjen Gajic

Research output: Contribution to journalArticle

27 Citations (Scopus)

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.

Original languageEnglish (US)
JournalGastrointestinal Endoscopy
Volume69
Issue number7
DOIs
StatePublished - Jun 2009

Fingerprint

Intratracheal Intubation
Critical Illness
Endoscopy
Intensive Care Units
Hemorrhage
Length of Stay
Intubation
Hospital Mortality
APACHE
Lung Diseases
Case-Control Studies
Patient Care
Incidence

ASJC Scopus subject areas

  • Gastroenterology
  • Radiology Nuclear Medicine and imaging

Cite this

Prophylactic endotracheal intubation in critically ill patients undergoing endoscopy for upper GI hemorrhage. / Rehman, Ahmer; Iscimen, Remzi; Yilmaz, Murat; Khan, Hasrat; Belsher, Jon; Gomez, Javier Fernandez; Hanson, Andrew C.; Afessa, Bekele; Baron, Todd H.; Gajic, Ognjen.

In: Gastrointestinal Endoscopy, Vol. 69, No. 7, 06.2009.

Research output: Contribution to journalArticle

Rehman, A, Iscimen, R, Yilmaz, M, Khan, H, Belsher, J, Gomez, JF, Hanson, AC, Afessa, B, Baron, TH & Gajic, O 2009, 'Prophylactic endotracheal intubation in critically ill patients undergoing endoscopy for upper GI hemorrhage', Gastrointestinal Endoscopy, vol. 69, no. 7. https://doi.org/10.1016/j.gie.2009.03.002
Rehman, Ahmer ; Iscimen, Remzi ; Yilmaz, Murat ; Khan, Hasrat ; Belsher, Jon ; Gomez, Javier Fernandez ; Hanson, Andrew C. ; Afessa, Bekele ; Baron, Todd H. ; Gajic, Ognjen. / Prophylactic endotracheal intubation in critically ill patients undergoing endoscopy for upper GI hemorrhage. In: Gastrointestinal Endoscopy. 2009 ; Vol. 69, No. 7.
@article{959b23271d84489ca2bc330fa05f1d18,
title = "Prophylactic endotracheal intubation in critically ill patients undergoing endoscopy for upper GI hemorrhage",
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.",
author = "Ahmer Rehman and Remzi Iscimen and Murat Yilmaz and Hasrat Khan and Jon Belsher and Gomez, {Javier Fernandez} and Hanson, {Andrew C.} and Bekele Afessa and Baron, {Todd H.} and Ognjen Gajic",
year = "2009",
month = "6",
doi = "10.1016/j.gie.2009.03.002",
language = "English (US)",
volume = "69",
journal = "Gastrointestinal Endoscopy",
issn = "0016-5107",
publisher = "Mosby Inc.",
number = "7",

}

TY - JOUR

T1 - Prophylactic endotracheal intubation in critically ill patients undergoing endoscopy for upper GI hemorrhage

AU - Rehman, Ahmer

AU - Iscimen, Remzi

AU - Yilmaz, Murat

AU - Khan, Hasrat

AU - Belsher, Jon

AU - Gomez, Javier Fernandez

AU - Hanson, Andrew C.

AU - Afessa, Bekele

AU - Baron, Todd H.

AU - Gajic, Ognjen

PY - 2009/6

Y1 - 2009/6

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=66049106020&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=66049106020&partnerID=8YFLogxK

U2 - 10.1016/j.gie.2009.03.002

DO - 10.1016/j.gie.2009.03.002

M3 - Article

VL - 69

JO - Gastrointestinal Endoscopy

JF - Gastrointestinal Endoscopy

SN - 0016-5107

IS - 7

ER -