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EDITORIAL
Year : 2017  |  Volume : 5  |  Issue : 3  |  Page : 199-200

Does endotracheal intubation reduce the incidence of cardiopulmonary complications in upper gastrointestinal bleeding?


Department of Internal Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia

Date of Web Publication21-Aug-2017

Correspondence Address:
Abdulaziz A Al-Quorain
P. O. Box 40001, Al-Khobar 31952
Kingdom of Saudi Arabia
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DOI: 10.4103/sjmms.sjmms_91_17

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How to cite this article:
Al-Quorain AA. Does endotracheal intubation reduce the incidence of cardiopulmonary complications in upper gastrointestinal bleeding?. Saudi J Med Med Sci 2017;5:199-200

How to cite this URL:
Al-Quorain AA. Does endotracheal intubation reduce the incidence of cardiopulmonary complications in upper gastrointestinal bleeding?. Saudi J Med Med Sci [serial online] 2017 [cited 2017 Nov 22];5:199-200. Available from: http://www.sjmms.net/text.asp?2017/5/3/199/213316

At present, upper gastrointestinal (GI) endoscopy is considered a safe procedure with low complication rates. According to various studies, the estimated overall rates of complications varies between 0.6/1000 and 5.4/1000 procedures, with mortality rates ranging from 0.01/1000 to 0.4/1000 procedures.[1] However, serious cardiopulmonary complications, caused by aspiration of gastric contents and blood, may occur in patients presenting with upper GI bleeding. The upper GI endoscopy-related complication rates range from 1% to 8%, and the overall complication rate can reach 12–23%. Cardiopulmonary complications are estimated at 23–50% of all adverse events in patients with upper GI bleeding and are responsible for 50–60% of deaths.[2]

In other studies, the mortality rate of patients with nonvariceal GI bleeding has been reported to be 3.5–10%,[3] while in patients with variceal GI bleeding, mortality rates can reach 15–20%.[4],[5] Prophylactic intubation is widely practiced in the Intensive Care Unit setting in cases of severe upper GI hemorrhage to protect the airways during the procedure, thereby decreasing the likelihood of expected cardiopulmonary complications.[6]

Aspiration of gastric contents and blood in patients with severe upper GI bleeding and in those subjected to upper GI endoscopy is considered one of the major complications. Another complication is lung infiltration, which can be seen radiologically in 4.8% of the patients within 4 h after the procedure.[7] In another large-scale study, a higher percentage of intubated patients (14%) developed pneumonia within 48 h after the procedure than nonintubated patients (2%).[7] The reason for this higher incidence of lung infiltrations in intubated patients is multifactorial, such as comorbid conditions: chronic liver disease and chronic renal and respiratory failures.[8],[9],[10]

However, none of the reviewed studies showed any evidence that prophylactic endotracheal intubation decreases the incidence of cardiopulmonary complications. Based on the results of these studies, the benefits of prophylactic endotracheal intubation remain controversial, and thus, additional prospective studies are needed to determine if any subgroup of patients may benefit from endotracheal intubation during upper GI endoscopy in severe GI bleeding.

 
  References Top

1.
Freeman ML. Sedation and monitoring for gastrointestinal endoscopy. In: Yamada T, editor. Textbook of Gastroenterology. Philadelphia: Lippincott, Williams and Wilkins; 1999. p. 2655-67.  Back to cited text no. 1
    
2.
Rudolph SJ, Landsverk BK, Freeman ML. Endotracheal intubation for airway protection during endoscopy for severe upper GI hemorrhage. Gastrointest Endosc 2003;57:58-61.  Back to cited text no. 2
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3.
Hwang JH, Fisher DA, Ben-Menachem T, Chandrasekhara V, Chathadi K, Decker GA, et al. The role of endoscopy in the management of acute non-variceal upper GI bleeding. Gastrointest Endosc 2012;75:1132-8.  Back to cited text no. 3
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4.
Garcia-Tsao G, Sanyal AJ, Grace ND, Carey W, Practice Guidelines Committee of the American Association for the Study of Liver Diseases, Practice Parameters Committee of the American College of Gastroenterology, et al. Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis. Hepatology 2007;46:922-38.  Back to cited text no. 4
    
5.
Hayat U, Lee PJ, Ullah H, Sarvepalli S, Lopez R, Vargo JJ, et al. Association of prophylactic endotracheal intubation in critically ill patients with upper GI bleeding and cardiopulmonary unplanned events. Gastrointest Endosc 2016. pii: S0016-5107(16) 30838-0.  Back to cited text no. 5
    
6.
Rehman A, Iscimen R, Yilmaz M, Khan H, Belsher J, Gomez JF, et al. Prophylactic endotracheal intubation in critically ill patients undergoing endoscopy for upper GI hemorrhage. Gastrointest Endosc 2009;69:e55-9.  Back to cited text no. 6
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7.
Lipper B, Simon D, Cerrone F. Pulmonary aspiration during emergency endoscopy in patients with upper gastrointestinal hemorrhage. Crit Care Med 1991;19:330-3.  Back to cited text no. 7
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8.
Kawanishi K, Kato J, Toda N, Yamagami M, Yamada T, Kojima K, et al. Risk factors for aspiration pneumonia after endoscopic hemostasis. Dig Dis Sci 2016;61:835-40.  Back to cited text no. 8
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9.
Koch DG, Arguedas MR, Fallon MB. Risk of aspiration pneumonia in suspected variceal hemorrhage: The value of prophylactic endotracheal intubation prior to endoscopy. Dig Dis Sci 2007;52:2225-8.  Back to cited text no. 9
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10.
Waye JD. Intubation and sedation in patients who have emergency upper GI endoscopy for GI bleeding. Gastrointest Endosc 2000;51:768-71.  Back to cited text no. 10
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