# Should Prophylactic Endotracheal Intubation Be Performed in Upper Gastrointestinal Bleeding?

## TL;DR

This study finds that prophylactic endotracheal intubation before endoscopy in hospitalized upper GI bleeding patients increases pneumonia risk and hospital stay but does not significantly raise mortality or aspiration risk.

## Contribution

A re-evaluation of prophylactic endotracheal intubation effects in upper GI bleeding using updated data from 2024.

## Key findings

- Prophylactic endotracheal intubation increases pneumonia odds (OR = 5.83) in hospitalized upper GI bleeding patients.
- Intubation is linked to longer hospital stays (MD = 0.84 days) but not to higher mortality or aspiration risk.
- Mortality and aspiration outcomes were not statistically significant between intubated and non-intubated groups.

## Abstract

No consensus exists on the standard of intraoperative airway management approach to prevent endoscopy complications in acute gastrointestinal (GI) bleeding. Eight years after our initial meta-analysis, we reassessed the effect of prophylactic endotracheal intubation in acute GI bleeding in hospitalized patients. Multiple databases were reviewed in 2024, identifying 10 studies that compared prophylactic endotracheal intubation (PEI) versus no intubation in acute upper GI bleeding in hospitalized patients. Outcomes of interest included pneumonia, length of hospital stay, aspiration, and mortality. The odds ratio (OR) or mean difference (MD) using the random effects model was calculated for each outcome. In total, 11 studies (10 retrospective, one prospective) were included in the meta-analysis (n = 7,332). PEI demonstrated statistically significant higher odds of pneumonia (OR = 5.83; 95% confidence interval (CI) = 3.15-10.79; p < 0.01) and longer length of stays (MD = 0.84; 95% CI = 0.12-1.56; p = 0.02). However, mortality (OR = 1.68; 95% CI = 0.78-3.64; p = 0.19) and aspiration (OR = 2.79; 95% CI = 0.89-8.7; p = 0.08) were not statistically significant. PEI before esophagogastroduodenoscopy for hospitalized upper GI bleeding patients is associated with an increased incidence of pneumonia within 48 hours and prolonged hospitalization but no statistically significant increased risk of mortality or aspiration.