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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.
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.
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.
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.
