S647 Should Prophylactic Endotracheal Intubation Be Performed in Upper GI Bleeding? A Meta-Analysis

Abstract

Introduction: Prophylactic endotracheal intubation in the setting of upper gastrointestinal bleeding (UGIB) prior to endoscopy is not uncommon. Many use this practice to prevent aspiration of blood or gastric contents. However, this practice is now controversial with results of studies being varied. Therefore, we performed the most comprehensive meta-analysis to-date to address this topic. Methods: A comprehensive search of multiple databases was performed (June 2022). Studies comparing pre-endoscopy prophylactic endotracheal intubation versus no prophylactic intubation in patients with UGIB were included. Analysis was performed using the random effects model with odds ratio (OR) and mean difference (MD) to assess for mortality, pneumonia within 48 hours, aspiration, and hospital length-of-stay (LOS). Publication bias and heterogeneity were assessed. Results: Eight studies met the inclusion criteria (n=5,769). Patients that underwent prophylactic intubation prior to endoscopy for UGIB experienced a statistically significant higher odds of pneumonia within 48 hours (OR 6.05; 95% CI: 4.01-9.14; p< 0.01) and longer hospital LOS (MD 0.84 days; 95% CI: 0.12-1.56; p=0.02) as compared to those without prophylactic intubation prior to endoscopy. However, no statistically significant differences were noted for mortality (OR 1.43; 95% CI: 0.58-3.51; p=0.44) and aspiration (OR 1.16; 95% CI: 0.48-2.77; p=0.74) between the two groups. Conclusion: UGIB patients that underwent prophylactic endotracheal intubation prior to endoscopy are more likely to develop pneumonia within 48 hours and to have longer hospital stays than patients not having prophylactic intubation. Based on these results, prophylactic endotracheal intubation prior to endoscopy does not seem to be beneficial in this population. Randomized controlled trials may be necessary to fully evaluate the utility of this practice in the future.