Role of Prophylactic Pre-Esophagogastroduodenoscopy (EGD) Endotracheal Intubation (ETI) in Upper Gastrointestinal Bleed (UGIB): A Retrospective Study

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Purpose: 1) To examine if pulmonary aspiration risk differ in patients who underwent prophylactic pre-EGD ETI, and no ETI; and 2) Assess whether the complications and the mortality differ between elective pre-EGD ETI and emergent post-EGD ETI. Methods: We reviewed patients with UGIB in the intensive care unit (ICU) who underwent EGD between the years 2000 and 2013. Mean (SD) and median (range) values were computed for continuous variables and frequency distributions were calculated for all categorical variables. All statistical tests were two-tailed with p<0.05 considered to be significant. Results: Eight hundred thirty-seven 837 ICU patients with UGIB and EGD were identified of which 89 (11%) fulfilled study criteria. Among these 89 patients, 69 (78%) underwent pre-EGD intubation (prophylactic) and 20 (22%) patients were intubated post-EGD (emergent). 69 (8%) patients were randomly selected who were not intubated. Univariate analysis showed that patients who underwent prophylactic pre-EGD intubation were more likely to be: younger [median (range): 61 (38-84) vs. 66 (30-95); p<0.04], to have a history of alcoholism 32 (46%) vs. 12 (17%); p<0.0003, to have cirrhosis 28 (41%) vs. 15 (22%); p<0.01), to have hematemesis 50 (75%) vs. 63 (91%); p<0.009, to have history of lung disease 19 (28%) vs. 9 (13%); p< 0.034, to have hepatic encephalopathy 10 (15%) vs. 3 (4%); p<0.041, and more likely to have sepsis 18 (27%) vs. 3 (4%); p<0.0003) than patients who were not intubated. Multivariable regression revealed that patients who underwent prophylactic pre-EGD intubation were more likely to have pulmonary aspiration than the patients who were not intubated (odds ratio [OR] 10.1; 95% confidence interval [CI] 2.9-35.1). They are also more likely to be hospitalized longer (14 vs. 7 days; p<0.0001) and to have longer ICU stays (10 vs. 3 days; p<0.0001). Patients who underwent elective prophylactic ETI prior to endoscopy were less likely to die during hospitalization than patients who received emergent post-EGD ETI 12 (19%) vs. 9 (45%); p<0.022.Table: Table. Outcome of patients who underwent prophylactic intubation with no intubation controlsTable: Table. Outcome of patients who underwent pre-EGD ETI with post-EGD ETIFigureConclusion: We found that prophylactic pre-EGD intubation may increase the risk for pulmonary aspiration, intensive care unit and hospital length of stay. Given the small sample size, these results should be taken with caution.

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