Zhao Yi-Ru, Wang Ya-Ting, Zhang Xue-Qun
Department of Gastroenterology, The First Affiliated Hospital, School of Medicine, Zhejiang University, No. 79 Qingchun Road, Hangzhou, Zhejiang, 310003, China.
BMC Gastroenterol. 2025 Jul 1;25(1):470. doi: 10.1186/s12876-025-04066-9.
Prophylactic endotracheal intubation (PEI) is widely performed before emergency endoscopy in patients with acute esophagogastric variceal bleeding (AEVB). However, its safety and benefits remain controversial. This study aims to evaluate the efficacy of PEI in patients with AEVB and the appropriate extubation time.
Patients with AEVB and underwent emergency endoscopy at The First Affiliated Hospital (04/2011-09/2023) were included and divided into PEI and non-PEI groups. Clinical outcomes included cardiopulmonary complications, incidence of automatic discharge or in-hospital death, hospital and intensive care unit (ICU) length of stay (LOS), and rebleeding rate in one month. Extubation time in patients with PEI was also analyzed.
Three patients had massive aspiration without PEI. Among 141 patients, 97 (68.8%) received PEI. Pneumonia and pulmonary edema were more frequent in the PEI group (42.3% vs. 25.0%; OR = 2.20, 95% CI: 1.00-4.86; P = 0.049; 26.8% vs. 6.8%; OR = 5.00, 95% CI: 1.42-17.55; P = 0.007), and the ICU LOS was also longer (P<0.001). Among patients with PEI, 29 (29.9%) patients were extubated within 24 h, and had a lower incidence of acute respiratory distress syndrome (ARDS) (4.4% vs. 17.2%, P = 0.049; adjusted P = 0.123), lower automatic discharge or in-hospital death rate (2.9% vs. 20.7%, P = 0.008), shorter ICU and hospital LOS (P<0.001).
PEI prior to emergency endoscopy may not protect patients with AEVB from cardiopulmonary complications or improve their prognosis, but it may prevent severe fatal aspiration. And early extubation appears to be associated with better clinical outcomes.
在急性食管胃静脉曲张出血（AEVB）患者进行急诊内镜检查前，预防性气管插管（PEI）广泛应用。然而，其安全性和益处仍存在争议。本研究旨在评估PEI对AEVB患者的疗效及合适的拔管时间。
纳入在第一附属医院（2011年4月至2023年9月）接受急诊内镜检查的AEVB患者，并分为PEI组和非PEI组。临床结局包括心肺并发症、自动出院或院内死亡发生率、住院和重症监护病房（ICU）住院时间（LOS）以及1个月内再出血率。还分析了PEI患者的拔管时间。
3例未行PEI的患者发生大量误吸。141例患者中，97例（68.8%）接受了PEI。PEI组肺炎和肺水肿更常见（42.3%对25.0%；OR = 2.20，95%CI：1.00 - 4.86；P = 0.049；26.8%对6.8%；OR = 5.00，95%CI：1.42 - 17.55；P = 0.007），且ICU住院时间也更长（P < 0.001）。在PEI患者中，29例（29.9%）在24小时内拔管，急性呼吸窘迫综合征（ARDS）发生率较低（4.4%对17.2%，P = 0.049；校正后P = 0.123），自动出院或院内死亡率较低（2.9%对20.7%，P = 0.008），ICU和住院LOS较短（P < 0.001）。
急诊内镜检查前的PEI可能无法保护AEVB患者免受心肺并发症或改善其预后，但可能预防严重致命性误吸。早期拔管似乎与更好的临床结局相关。
