Prophylactic tracheal intubation for upper GI bleeding: A meta-analysis.

世界荟萃分析杂志(英文版) Pub Date : 2015-02-26 DOI:10.13105/wjma.v3.i1.4

Ashraf A Almashhrawi, Rubayat Rahman, Samuel T Jersak, Akwi W Asombang, Alisha M Hinds, Hazem T Hammad, Douglas L Nguyen, Matthew L Bechtold

{"title":"Prophylactic tracheal intubation for upper GI bleeding: A meta-analysis.","authors":"Ashraf A Almashhrawi, Rubayat Rahman, Samuel T Jersak, Akwi W Asombang, Alisha M Hinds, Hazem T Hammad, Douglas L Nguyen, Matthew L Bechtold","doi":"10.13105/wjma.v3.i1.4","DOIUrl":null,"url":null,"abstract":"Aim: To evaluate usefulness of prophylactically intubating upper gastrointestinal bleeding (UGIB) patients.Methods: UGIB results in a significant number of hospital admissions annually with endoscopy being the key intervention. In these patients, risks are associated with the bleeding and the procedure, including pulmonary aspiration. However, very little literature is available assessing the use of prophylactic endotracheal intubation on aspiration in these patients. A comprehensive search was performed in May 2014 in Scopus, CINAHL, Cochrane databases, PubMed/Medline, Embase, and published abstracts from national gastroenterology meetings in the United States (2004-2014). Included studies examined UGIB patients and compared prophylactic intubation to no intubation before endoscopy. Meta-analysis was conducted using RevMan 5.2 by Mantel-Haenszel and DerSimonian and Laird models with results presented as odds ratio for aspiration, pneumonia (within 48 h), and mortality. Funnel plots were utilized for publication bias and I2 measure of inconsistency for heterogeneity assessments.Results: Initial search identified 571 articles. Of these articles, 10 relevant peer-reviewed articles in English and two relevant abstracts were selected to review by two independent authors (Almashhrawi AA and Bechtold ML). Of these studies, eight were excluded: Five did not have a control arm, one was a letter the editor, one was a survey study, and one was focused on prevention of UGIB. Therefore, four studies (N = 367) were included. Of the UGIB patients prophylactically intubated before endoscopy, pneumonia (within 48 h) was identified in 20 of 134 (14.9%) patients as compared to 5 of 95 (5.3%) patients that were not intubated prophylactically (P = 0.02). Despite observed trends, no significant differences were found for mortality (P = 0.18) or aspiration (P = 0.11).Conclusion: Pneumonia within 48 h is more likely in UGIB patients who received prophylactic endotracheal intubation prior to endoscopy.","PeriodicalId":65781,"journal":{"name":"世界荟萃分析杂志(英文版)","volume":"3 1","pages":"4-10"},"PeriodicalIF":0.0000,"publicationDate":"2015-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.13105/wjma.v3.i1.4","citationCount":"18","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"世界荟萃分析杂志(英文版)","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.13105/wjma.v3.i1.4","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}

引用次数: 18

Abstract

Aim: To evaluate usefulness of prophylactically intubating upper gastrointestinal bleeding (UGIB) patients.

Methods: UGIB results in a significant number of hospital admissions annually with endoscopy being the key intervention. In these patients, risks are associated with the bleeding and the procedure, including pulmonary aspiration. However, very little literature is available assessing the use of prophylactic endotracheal intubation on aspiration in these patients. A comprehensive search was performed in May 2014 in Scopus, CINAHL, Cochrane databases, PubMed/Medline, Embase, and published abstracts from national gastroenterology meetings in the United States (2004-2014). Included studies examined UGIB patients and compared prophylactic intubation to no intubation before endoscopy. Meta-analysis was conducted using RevMan 5.2 by Mantel-Haenszel and DerSimonian and Laird models with results presented as odds ratio for aspiration, pneumonia (within 48 h), and mortality. Funnel plots were utilized for publication bias and I² measure of inconsistency for heterogeneity assessments.

Results: Initial search identified 571 articles. Of these articles, 10 relevant peer-reviewed articles in English and two relevant abstracts were selected to review by two independent authors (Almashhrawi AA and Bechtold ML). Of these studies, eight were excluded: Five did not have a control arm, one was a letter the editor, one was a survey study, and one was focused on prevention of UGIB. Therefore, four studies (N = 367) were included. Of the UGIB patients prophylactically intubated before endoscopy, pneumonia (within 48 h) was identified in 20 of 134 (14.9%) patients as compared to 5 of 95 (5.3%) patients that were not intubated prophylactically (P = 0.02). Despite observed trends, no significant differences were found for mortality (P = 0.18) or aspiration (P = 0.11).

Conclusion: Pneumonia within 48 h is more likely in UGIB patients who received prophylactic endotracheal intubation prior to endoscopy.

Abstract Image

查看原文

微信好友朋友圈 QQ好友复制链接

本刊更多论文

预防性气管插管治疗上消化道出血:荟萃分析。

目的:评价预防性上消化道出血(UGIB)患者插管治疗的有效性。方法:UGIB每年导致大量住院，内镜检查是关键干预措施。在这些患者中，风险与出血和手术有关，包括肺误吸。然而，很少有文献评估在这些患者中预防性气管内插管的使用。2014年5月，我们在Scopus、CINAHL、Cochrane数据库、PubMed/Medline、Embase以及2004-2014年美国国家胃肠病学会议发表的摘要中进行了全面检索。纳入的研究检查了UGIB患者，并比较了内镜检查前预防性插管和不插管。meta分析采用RevMan 5.2，采用Mantel-Haenszel、DerSimonian和Laird模型，结果显示为误吸、肺炎(48 h内)和死亡率的优势比。发表偏倚采用漏斗图，异质性评估采用I2测量不一致性。结果:初步搜索确定了571篇文章。在这些文章中，选择了10篇相关的英文同行评议文章和两篇相关的摘要，由两位独立作者(Almashhrawi AA和Bechtold ML)进行评审。在这些研究中，有8项被排除在外:5项没有对照组，1项是一封给编辑的信，1项是一项调查研究，1项侧重于预防UGIB。因此，纳入了4项研究(N = 367)。在内镜检查前预防性插管的UGIB患者中，134例患者中有20例(14.9%)诊断出肺炎(48小时内)，而95例未预防性插管的患者中有5例(5.3%)诊断出肺炎(P = 0.02)。尽管观察到趋势，但在死亡率(P = 0.18)或误吸(P = 0.11)方面没有发现显著差异。结论:内镜检查前接受预防性气管插管的UGIB患者48 h内更易发生肺炎。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文去求助