A48 PROPHYLACTIC ENDOTRACHEAL INTUBATION IN CRITICALLY ILL PATIENTS WITH UPPER GASTROINTESTINAL BLEED: A SYSTEMATIC REVIEW AND META-ANALYSIS
Bibliographic record
Abstract
To compare clinical outcomes and perform a cost analysis of prophylactic endotracheal intubation compared to no intubation in upper gastrointestinal bleeding (UGIB). EMBASE, MEDLINE, and the Cochrane Central Register of Controlled Trials were used to identify studies through June 2017. Studies performed comparing prophylactic intubation to no intubation in UGIB in adults were included. Studies were excluded that did not report on at least one of the a priori established clinical outcomes. Two authors collected and assessed the data independently. Data on mortality, length of stay (LOS), cardiac complications and rates of pneumonia was collected. DerSimonian-Laird random effects models were used to calculate the inverse variance-based weighted, pooled treatment effect across studies. Seven studies (five manuscripts and two abstracts) were identified including a total of 5662 patients. Prophylactic intubation conferred increased mortality compared to no intubation (odds ratio [OR], 2.59; 95% CI [1.01 – 6.64], P = 0.05; I2 = 94%). The hospital LOS was higher in the prophylactic intubation group (mean difference [MD], 0.96 days; 95% CI [0.26 – 1.67], P = 0.007; I2 = 0). The prophylactic intubation group had significantly higher rates of pneumonia (OR, 6.58; 95% CI [4.91 – 8.81], P <0.0001; I2 = 0%) and significantly higher rates of cardiac complications (OR, 2.11; 95% CI [1.04 – 4.27], P = 0.04; I2 = 6%). There was a trend towards increased ICU LOS in the prophylactically intubated group, though this difference was not statistically significant. Using a previously published costing method based on length of stay, the prophylactically intubated group incurred costs of $9020 per patient (95% CI: 6962 – 10609) compared to $7510 per patient (95% CI: 6486 – 8432) in the non-intubated group. Prophylactic intubation in UGIB is associated with higher rates of pneumonia, cardiac complications, hospital LOS and overall mortality. Furthermore, it shows a trend towards higher cost and longer ICU LOS. Because the studies included in this review were retrospective, further large prospective trials are needed to evaluate this topic further. None
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.010 | 0.024 |
| Meta-epidemiology (narrow) | 0.003 | 0.001 |
| Meta-epidemiology (broad) | 0.021 | 0.044 |
| Bibliometrics | 0.009 | 0.008 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.002 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.005 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".