Meta-Analysis
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Meta-Anal. Feb 26, 2015; 3(1): 4-10
Published online Feb 26, 2015. doi: 10.13105/wjma.v3.i1.4
Prophylactic tracheal intubation for upper GI bleeding: A meta-analysis
Ashraf A Almashhrawi, Rubayat Rahman, Samuel T Jersak, Akwi W Asombang, Alisha M Hinds, Hazem T Hammad, Douglas L Nguyen, Matthew L Bechtold
Ashraf A Almashhrawi, Rubayat Rahman, Samuel T Jersak, Akwi W Asombang, Alisha M Hinds, Hazem T Hammad, Matthew L Bechtold, Division of Gastroenterology and Hepatology, University of Missouri, Columbia, MO 65212, United States
Douglas L Nguyen, Division of Gastroenterology and Hepatology, University of California, Irvine, CA 92697, United States
Author contributions: Almashhrawi AA, Nguyen DL and Bechtold ML were responsible for the conception and design of the study; Almashhrawi AA, Rahman R, Jersak ST and Hinds AM collected the data and organized data extraction sheets; Hammad HT, Nguyen DL and Bechtold ML statistically analyzed the data; Almashhrawi AA, Rahman R and Jersak ST drafted the manuscript with critical revision being performed by Asombang AW, Hammad HT, Nguyen DL and Bechtold ML.
Conflict-of-interest: The authors have no conflicts of interest for this manuscript.
Data sharing: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Matthew L Bechtold, MD, FACP, FASGE, FACG, Division of Gastroenterology and Hepatology, University of Missouri, Five Hospital Drive, Columbia, MO 65212, United States. bechtoldm@health.missouri.edu
Telephone: +1-573-8821013 Fax: +1-573-8844595
Received: October 28, 2014
Peer-review started: October 28, 2014
First decision: November 14, 2014
Revised: December 22, 2014
Accepted: January 9, 2015
Article in press: January 12, 2015
Published online: February 26, 2015
Processing time: 175 Days and 7.3 Hours
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.

Keywords: Prophylactic endotracheal intubation; Upper gastrointestinal bleeding; Endoscopy; Complication; Pneumonia; Aspiration

Core tip: Patients with upper gastrointestinal bleeding (UGIB) require endoscopic treatment with variable outcomes of aspiration, pneumonia, non-endoscopic interventions, and mortality. It is suggested that endotracheal intubation prior to endoscopy might reduce aspiration, pneumonia, and mortality. Few studies have evaluated this issue. We performed a meta-analysis of observational studies examining endotracheal intubation vs no intubation in UGIB patients. We found that patients intubated had higher incidence of pneumonia within 48 h. There was no significant increase in aspiration and mortality in the intubated group. This meta-analysis demonstrates the need for randomized controlled trials to assess the issue.