Prophylactic Endotracheal Intubation Prior to Urgent Endoscopy in Patients with Suspected Variceal Hemorrhage: An Evaluation of Outcomes and Complications

Abstract

AIM: There is limited evidence that suggests prophylactic intubation improves patient outcomes despite wide utilization. Our study aims to evaluate outcomes and complications related to prophylactic intubation through a retrospective comparison. MATERIALS AND METHODS: Urgent esophagogastroduodenoscopy (EGD) for suspected variceal hemorrhage were included in the study and categorized into two cohorts, one with prophylactic intubation and one without. Primary outcomes for the study were immediate aspiration, post EGD pneumonia, death, and other complications. Secondary outcomes included post EGD intensive care unit (ICU) stay, total ICU stay and total hospital stay. Retrospective comparison between cohorts was performed. RESULTS: Total 110 occurrences of urgent EGD were included. Prophylactic intubation was performed in 65 occurrence. Demographics, clinical background and significant comorbidities were similar in both cohorts. Immediate aspiration, post EGD pneumonia, and mortality were similar in both cohorts. Complications other than cardiac and pulmonary related were higher in prophylactic intubation group than no intubation group (40% vs 17.78%, P = 0.02). Overall average hospital stay of both cohorts and overall average ICU stay were similar. Average ICU stay post EGD was significant longer in prophylactic intubation group than no intubation group (4.7 ± 3.9 days vs 2.6 ± 2.6 days, P = 0.002). CONCLUSION: Our study revealed that prophylactic intubation prior to urgent EGD for variceal hemorrhage (VH) did not improve clinical outcomes. Our finding would suggest against routine prophylactic intubation in patients having VH with only mild encephalopathy and no ongoing hemorrhage.