Cardiopulmonary prognosis of prophylactic endotracheal intubation in patients with upper gastrointestinal bleeding undergoing endoscopy  

作　　者：Yufang Lin Fei’er Song Weiyue Zeng Yichi Han Xiujuan Chen Xuanhui Chen Yu Ouyang Xueke Zhou Guoxiang Zou Ruirui Wang Huixian Li Xin Li 

机构地区：[1]School of Biology and Biological Engineering,South China University of Technology,Guangzhou 510006,China [2]Department of Emergency Medicine,Guangdong Provincial People's Hospital,Guangdong Academy of Medical Sciences,Guangzhou 510080,China [3]Medical Big Data Center,Guangdong Provincial People's Hospital,Guangdong Academy of Medical Sciences,Guangzhou 510080,China [4]School of Medicine,South China University of Technology,Guangzhou 510006,China [5]Guangdong Cardiovascular Institute,Guangdong Provincial People's Hospital,Guangdong Academy of Medical Sciences,Guangzhou 510100,China

出　　处：《World Journal of Emergency Medicine》2023年第5期372-379,共8页世界急诊医学杂志（英文）

基　　金：supported by grants from the Ministry of Science and Technology of the People’s Republic of China(2020AAA0109605);the National Natural Science Grant of China(82072225,82272246);High-level Hospital Construction Project of Guangdong Provincial People’s Hospital(DFJHBF202104);Science and Technology Program of Guangzhou(202206010044);Leading Medical Talents in Guangdong Province of Guangdong Provincial People’s Hospital(KJ012019425)。

摘　　要：BACKGROUND:It is controversial whether prophylactic endotracheal intubation(PEI)protects the airway before endoscopy in critically ill patients with upper gastrointestinal bleeding(UGIB).The study aimed to explore the predictive value of PEI for cardiopulmonary outcomes and identify high-risk patients with UGIB undergoing endoscopy.METHODS:Patients undergoing endoscopy for UGIB were retrospectively enrolled in the eICU Collaborative Research Database(eICU-CRD).The composite cardiopulmonary outcomes included aspiration,pneumonia,pulmonary edema,shock or hypotension,cardiac arrest,myocardial infarction,and arrhythmia.The incidence of cardiopulmonary outcomes within 48 h after endoscopy was compared between the PEI and non-PEI groups.Logistic regression analyses and propensity score matching analyses were performed to estimate effects of PEI on cardiopulmonary outcomes.Moreover,restricted cubic spline plots were used to assess for any threshold effects in the association between baseline variables and risk of cardiopulmonary outcomes(yes/no)in the PEI group.RESULTS:A total of 946 patients were divided into the PEI group(108/946,11.4%)and the non-PEI group(838/946,88.6%).After propensity score matching,the PEI group(n=50)had a higher incidence of cardiopulmonary outcomes(58.0%vs.30.3%,P=0.001).PEI was a risk factor for cardiopulmonary outcomes after adjusting for confounders(odds ratio[OR]3.176,95%confidence interval[95%CI]1.567-6.438,P=0.001).The subgroup analysis indicated the similar results.A shock index>0.77 was a predictor for cardiopulmonary outcomes in patients undergoing PEI(P=0.015).The probability of cardiopulmonary outcomes in the PEI group depended on the Charlson Comorbidity Index(OR 1.465,95%CI 1.079-1.989,P=0.014)and shock index>0.77(compared with shock index≤0.77[OR 2.981,95%CI 1.186-7.492,P=0.020,AUC=0.764]).CONCLUSION:PEI may be associated with cardiopulmonary outcomes in elderly and critically ill patients with UGIB undergoing endoscopy.Furthermore,a shock index greater than 0.77 could be used a

关 键 词：Prophylactic endotracheal intubation Upper gastrointestinal bleeding Cardiopulmonary outcomes eICU Collaborative Research Database 

分 类 号：R573.2[医药卫生—消化系统]