上消化道出血患者在内镜检查时预防性气管插管的心肺预后
Cardiopulmonary prognosis of prophylactic endotracheal intubation in patients with upper gastrointestinal bleeding undergoing endoscopy.
作者信息
Lin Yufang, Song Fei'er, Zeng Weiyue, Han Yichi, Chen Xiujuan, Chen Xuanhui, Ouyang Yu, Zhou Xueke, Zou Guoxiang, Wang Ruirui, Li Huixian, Li Xin
机构信息
School of Biology and Biological Engineering, South China University of Technology, Guangzhou 510006, China.
Department of Emergency Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China.
出版信息
World J Emerg Med. 2023;14(5):372-379. doi: 10.5847/wjem.j.1920-8642.2023.080.
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 (=50) had a higher incidence of cardiopulmonary outcomes (58.0% vs. 30.3%, =0.001). PEI was a risk factor for cardiopulmonary outcomes after adjusting for confounders (odds ratio [] 3.176, 95% confidence interval [95% ] 1.567-6.438, =0.001). The subgroup analysis indicated the similar results. A shock index >0.77 was a predictor for cardiopulmonary outcomes in patients undergoing PEI (=0.015). The probability of cardiopulmonary outcomes in the PEI group depended on the Charlson Comorbidity Index ( 1.465, 95% 1.079-1.989, =0.014) and shock index >0.77 (compared with shock index ≤0.77 [ 2.981, 95% 1.186-7.492, =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 as a predictor of a worse prognosis in patients undergoing PEI.
背景
对于上消化道出血（UGIB）的重症患者，在内镜检查前预防性气管插管（PEI）是否能保护气道存在争议。本研究旨在探讨PEI对心肺结局的预测价值，并识别接受内镜检查的UGIB高危患者。
方法
对因UGIB接受内镜检查的患者进行回顾性纳入eICU协作研究数据库（eICU-CRD）。复合心肺结局包括误吸、肺炎、肺水肿、休克或低血压、心脏骤停、心肌梗死和心律失常。比较PEI组和非PEI组内镜检查后48小时内心肺结局的发生率。进行逻辑回归分析和倾向评分匹配分析以评估PEI对心肺结局的影响。此外，使用受限立方样条图评估PEI组中基线变量与心肺结局风险（是/否）之间关联的任何阈值效应。
结果
共946例患者分为PEI组（108/946，11.4%）和非PEI组（838/946，88.6%）。倾向评分匹配后，PEI组（=50）的心肺结局发生率更高（58.0%对30.3%，=0.001）。校正混杂因素后，PEI是心肺结局的危险因素（比值比[]3.176，95%置信区间[95%]1.567 - 6.438，=0.001）。亚组分析显示了相似的结果。休克指数>0.77是接受PEI患者心肺结局的预测因素（=0.015）。PEI组中心肺结局的概率取决于Charlson合并症指数（1.465，95%1.079 - 1.989，=0.014）和休克指数>0.77（与休克指数≤0.77相比[2.981，95%1.186 - 7.492，=0.020，AUC = 0.764]）。
结论
PEI可能与接受内镜检查的老年UGIB重症患者的心肺结局相关。此外，休克指数大于0.77可作为接受PEI患者预后较差的预测指标。
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