Table 1.
Characteristics of included studies
| Author | Design | Population | Interventions | Definition of aspiration | Definition of pneumonia |
|---|---|---|---|---|---|
| Lipper,[1] USA (n = 30) | Case series | ICU admission for active and severe UGIB Age: NR Males: 50% | PEI (n = 6) Usual care (n = 24) Both groups: endoscopy within 12 hours of admission | Direct observation by authors during EGD | New infiltrate on CXR and any one of the following: Fever Leukocytosis |
| Koch,[17] USA (n = 62) | Retrospective cohort | Active esophageal varices bleeding or varices with high-risk stigmata and blood in the stomach Age (mean): 48.7 years Males: 71% Child–Pugh score (mean): 8.6 Encephalopathy (Grade I): 23% | PEI (n = 42) Usual care (n = 20) Both groups: endoscopy within 12 hours of admission | Clinical diagnosis of aspiration by the primary team | Aspiration pneumonia: New pulmonary infiltrates on the post-EGD CXR, or Clinical diagnosis of aspiration by the primary team |
| Rehman,[19] USA (n = 98) | Retrospective case-control | Medical ICU admitted for UGIB with cirrhosis, hematemesis or shock. Age (median): 65 years Males: 62% | PEI (n = 49) Usual care: (n = 49) | Witnessed or suspected abnormal entry of secretions, fluid or particles into lower respiratory airways within 48 hours after EGD | New infiltrate CXR with any two of the following within 48 hours after EGD: Fever Leukocytosis Purulent sputum |
| Perisetti,[10] (Abstract) USA (n = 138) | Retrospective | Admitted to ICU with UGIB Age (mean): 63.5 years Males: NR | PEI (n = 69) Usual care: (n = 69) | NR | NR |
| Lohse,[18] Denmark (n = 3580) | Retrospective database | Nationwide registry of patients with peptic ulcer bleeding undergoing emergency EGD under anesthesia care. Age (mean): 75 years Males: 54% | PEI (n = 2101) Usual care: (n = 1479) | NR | NR |
| Abdulsamad,[11] (Abstract) USA (n = 1474) | Retrospective cohort | UGIB defined as hematemesis, coffee ground emesis or melena who underwent EGD | PEI (n = 264) Usual care (n = 1219) | NR | NR |
| Lee,[12] (Abstract) USA (n = 156) | Retrospective cohort | EGD in ICU for UGIB defined as one of: Hematemesis patient Melena hypovolemic shock with/without cirrhosis Age: NR Males: NR | PEI (n = 78) Usual care (n = 78) | NR | Within 48 hours post-EGD but no definition provided |
| Hayat,[13] USA (n = 200) | Retrospective cohort | EGD in ICU for UGIB defined as one of the following: Hematemesis patient Melena hypovolemic shock (SBP <90 mm Hg and HR >100 beats/min requiring either fluids or vasopressor agents) with/without cirrhosis Age (mean): 59.3 years Males: 63.5% | PEI (n =100) Usual care (n = 100) | NR | New focal infiltrates on CXR with any two of the following: Fever Leukocytosis Productive cough |
| Tang,[21] USA (n = 110) | Retrospective cohort | Medical ICU patients with cirrhosis and hematemesis with EGD findings of active variceal bleeding or blood in stomach plus presence of varices with high-risk stigmata Age (mean): 55 years Males: 67.6% | PEI (n = 65) Usual care (n = 45) | NR | New infiltrate on CXR plus any two the following findings within 48 hours after EGD: Fever (temperature >100.8°F) Leukocytosis (WBC >10,000/mm3) Purulent sputum |
| Rudolph,[14] USA (n = 220) | Retrospective before and after | Admitted to ICU with UGIB in 1988 and 1992 | PEI (n = 21) No intubation (n = 161) | Witnessed aspiration or new infiltrate on CXR | Not an outcome |
PEI – Prophylactic endotracheal intubation; CXR – Chest X-ray; EGD – Esophagogastroduodenoscopy; HR – Heart rate; ICU – Intensive care unit; NR – Not reported; SBP – Systolic blood pressure; UGIB – Upper gastrointestinal bleeding; WBC – White blood cells