Prophylactic endotracheal intubation in critically ill patients undergoing endoscopy for upper GI hemorrhage.
Prophylactic endotracheal intubation in critically ill patients undergoing endoscopy for upper GI hemorrhage.
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DOI：
10.1016/j.gie.2009.03.002
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发表时间：
2009-06-01
影响因子：
7.7
通讯作者：
Gajic, Ognjen
中科院分区：
文献类型：
--
作者：
Rehman, Ahmer;Iscimen, Remzi;Gajic, Ognjen
背景：重症监护室（ICU）上消化道（UGI）出血内镜检查后，心肺并发症很常见。目的：评价ICU UGI出血内镜前选择性预防性气管插管的做法和效果。设计：回顾性、倾向匹配的病例对照研究。环境：三级医疗中心的24张病床的医疗ICU。患者：ICU患者因UGI出血行内窥镜检查。主要结局测量：心肺并发症、ICU和住院时间、死亡率。在倾向分析中，在UGI内窥镜检查前插管以保护气道的患者与在UGI内窥镜检查前未插管的对照组的插管概率相匹配。结果：307例患者中，53例在UGI内镜检查前进行了选择性预防性插管。插管的可能性取决于急性生理和慢性健康评估III （APACHE III）评分（OR 1.4; 95% CI, 1.2-1.6）、年龄（OR 0.97; 95% CI, 0.95-0.09）、是否存在呕血（OR 1.9; 95% CI, 0.8-5.1）、既往肺部疾病（OR 2.1; 95% CI, 0.8-4.9）和输血次数（OR 1.1; 95% CI, 1.0-1.1 /单位）。除4例活动性大出血患者外，所有患者均采用非插管匹配对照，这些患者被排除在匹配分析之外。心肺并发症的累积发生率（53%对45%，P = .414）、ICU住院时间（中位2.2对1.8天，P = .138）、住院时间（6.9对5.9天，P = .785）和住院死亡率（14%对20%，P = .366）相似。结论：ICU患者急性UGI出血内镜检查后常见心肺并发症，并且在很大程度上不受预防性插管的影响。
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.