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

World Journal of Meta-Analysis 2015年第1期3卷 4-10页

作者： Ashraf A Almashhrawi Rubayat Rahman samuel t jersak Akwi W Asombang Alisha M Hinds Hazem t Hammad Douglas L Nguyen Matthew L Bechtold Division of Gastroenterology and Hepa-tology University of Missouri Columbia MO 65212 United States Division of Gastroenterology and Hepa-tology University of California Irvine CA 92697 United States

AIM： to evaluate usefulness of prophylactically intu-bating 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 identi？ed 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 p

关键词： Prophylactic endotracheal intubation Upper gastrointestinal bleeding Endoscopy Complication Pneumonia Aspiration

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