Outcomes and Practices of Endotracheal Intubation Using the Glasgow Coma Scale in Acute Non-Traumatic Poisoning: A Systematic Review and Meta-Analysis of Proportions
Acute poisoning often results in decreased consciousness, necessitating airway assessment and management. Existing literature in the trauma setting suggests the importance of airway protection in unconscious patients to prevent complications, including aspiration. Practices for endotracheal intubati...
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| creator | Nanah, Abdelrahman Abdeljaleel, Fatima Matsubara, Júlio Ken Garcia, Marcos Vinicius Fernandes |
| description | Acute poisoning often results in decreased consciousness, necessitating airway assessment and management. Existing literature in the trauma setting suggests the importance of airway protection in unconscious patients to prevent complications, including aspiration. Practices for endotracheal intubation in non-traumatic acute poisoning are poorly described and variable, particularly regarding the use of a Glasgow Coma Scale (GCS) ≤ 8 threshold for intubation.
A systematic review and meta-analysis of proportions was conducted to evaluate intubation rates and outcomes in patients presenting for acute non-traumatic poisoning. Studies were excluded if the primary indication for intubation was not airway protection. We analyzed rates of intubation, mortality, and aspiration by subgrouping patients into GCS ≤ 8, GCS 9-15, or mixed GCS. Common and random-effects analysis were used, supplemented by subgroup analyses.
39 studies were included in the analysis, involving 15,959 patients. Random-effects pooled intubation rates varied significantly across GCS categories: GCS ≤ 8 (30.0%, I
= 92%, p |
| doi_str_mv | 10.1177/08850666241275041 |
| format | Article |
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A systematic review and meta-analysis of proportions was conducted to evaluate intubation rates and outcomes in patients presenting for acute non-traumatic poisoning. Studies were excluded if the primary indication for intubation was not airway protection. We analyzed rates of intubation, mortality, and aspiration by subgrouping patients into GCS ≤ 8, GCS 9-15, or mixed GCS. Common and random-effects analysis were used, supplemented by subgroup analyses.
39 studies were included in the analysis, involving 15,959 patients. Random-effects pooled intubation rates varied significantly across GCS categories: GCS ≤ 8 (30.0%, I
= 92%, p < 0.01), GCS 9-15 (1.0%, I
= 0%, p = 0.91), and mixed GCS (11.0%, I
= 94%, p < 0.01), p-value <0.01 for subgroup difference. Aspiration rates also varied: GCS ≤ 8 (19.0%, I
= 84%, p < 0.01), GCS 9-15 (4.0%, I
= 78%, p < 0.01), and mixed group (5.0%, I
= 72%, p < 0.01), p-value <0.01 for subgroup difference. Mortality rates remained low across all groups: GCS ≤ 8 (1.0%, I
= 0%, p = 0.62), GCS 9-15 (1.0%, I
= 0%, p = 0.99), and mixed group (2.0%, I
= 68%, p < 0.01).
The conventional "less than 8, intubate" approach may not be directly applicable to acute poisoning patients due to heterogeneity in patient presentation, intubation practices, and low mortality. Therefore, a nuanced approach is warranted to optimize airway management strategies tailored to individual patient needs.]]></description><identifier>ISSN: 1525-1489</identifier><identifier>EISSN: 1525-1489</identifier><identifier>DOI: 10.1177/08850666241275041</identifier><identifier>PMID: 39150325</identifier><language>eng</language><publisher>United States</publisher><ispartof>Journal of intensive care medicine, 2024-08, p.8850666241275041</ispartof><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><orcidid>0000-0003-2633-7325 ; 0009-0007-2934-9889</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27923,27924</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/39150325$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Nanah, Abdelrahman</creatorcontrib><creatorcontrib>Abdeljaleel, Fatima</creatorcontrib><creatorcontrib>Matsubara, Júlio Ken</creatorcontrib><creatorcontrib>Garcia, Marcos Vinicius Fernandes</creatorcontrib><title>Outcomes and Practices of Endotracheal Intubation Using the Glasgow Coma Scale in Acute Non-Traumatic Poisoning: A Systematic Review and Meta-Analysis of Proportions</title><title>Journal of intensive care medicine</title><addtitle>J Intensive Care Med</addtitle><description><![CDATA[Acute poisoning often results in decreased consciousness, necessitating airway assessment and management. Existing literature in the trauma setting suggests the importance of airway protection in unconscious patients to prevent complications, including aspiration. Practices for endotracheal intubation in non-traumatic acute poisoning are poorly described and variable, particularly regarding the use of a Glasgow Coma Scale (GCS) ≤ 8 threshold for intubation.
A systematic review and meta-analysis of proportions was conducted to evaluate intubation rates and outcomes in patients presenting for acute non-traumatic poisoning. Studies were excluded if the primary indication for intubation was not airway protection. We analyzed rates of intubation, mortality, and aspiration by subgrouping patients into GCS ≤ 8, GCS 9-15, or mixed GCS. Common and random-effects analysis were used, supplemented by subgroup analyses.
39 studies were included in the analysis, involving 15,959 patients. Random-effects pooled intubation rates varied significantly across GCS categories: GCS ≤ 8 (30.0%, I
= 92%, p < 0.01), GCS 9-15 (1.0%, I
= 0%, p = 0.91), and mixed GCS (11.0%, I
= 94%, p < 0.01), p-value <0.01 for subgroup difference. Aspiration rates also varied: GCS ≤ 8 (19.0%, I
= 84%, p < 0.01), GCS 9-15 (4.0%, I
= 78%, p < 0.01), and mixed group (5.0%, I
= 72%, p < 0.01), p-value <0.01 for subgroup difference. Mortality rates remained low across all groups: GCS ≤ 8 (1.0%, I
= 0%, p = 0.62), GCS 9-15 (1.0%, I
= 0%, p = 0.99), and mixed group (2.0%, I
= 68%, p < 0.01).
The conventional "less than 8, intubate" approach may not be directly applicable to acute poisoning patients due to heterogeneity in patient presentation, intubation practices, and low mortality. Therefore, a nuanced approach is warranted to optimize airway management strategies tailored to individual patient needs.]]></description><issn>1525-1489</issn><issn>1525-1489</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><recordid>eNpNkM1OAjEUhRujEUQfwI3p0s1of6bz444QRBIUIrAmdzodqJlpcdqR8EC-pyNg4uree3LO_ZKD0C0lD5TG8SNJEkGiKGIhZbEgIT1DXSqYCGiYpOf_9g66cu6DEMoZp5eow1MqCGeii76njZe2Ug6DyfGsBum1bC9b4KHJrW-FjYISj41vMvDaGrx02qyx3yg8KsGt7Q4PbAV4LqFUWBvcl41X-M2aYFFDU7UhiWdWO2va3BPu4_neeXXU39WXVrsD-1V5CPoGyr3TB_6stltb_yLdNboooHTq5jR7aPk8XAxegsl0NB70J8GWhtQHRcEjEjKgPJJJISCSKpUpz2QOGStUKMI0z8NCiqyAhNEoEzSPQXAec0ayNtZD98e_29p-Nsr5VaWdVGUJRtnGrThJuUjbpkVrvTtZm6xS-Wpb6wrq_eqvWv4DeBR-Gg</recordid><startdate>20240816</startdate><enddate>20240816</enddate><creator>Nanah, Abdelrahman</creator><creator>Abdeljaleel, Fatima</creator><creator>Matsubara, Júlio Ken</creator><creator>Garcia, Marcos Vinicius Fernandes</creator><scope>NPM</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-2633-7325</orcidid><orcidid>https://orcid.org/0009-0007-2934-9889</orcidid></search><sort><creationdate>20240816</creationdate><title>Outcomes and Practices of Endotracheal Intubation Using the Glasgow Coma Scale in Acute Non-Traumatic Poisoning: A Systematic Review and Meta-Analysis of Proportions</title><author>Nanah, Abdelrahman ; Abdeljaleel, Fatima ; Matsubara, Júlio Ken ; Garcia, Marcos Vinicius Fernandes</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-p141t-ff36042a136c8f5a6ce9c93bcdab2fe4549dd4fc5bfa8216b51d7a5337320ba13</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Nanah, Abdelrahman</creatorcontrib><creatorcontrib>Abdeljaleel, Fatima</creatorcontrib><creatorcontrib>Matsubara, Júlio Ken</creatorcontrib><creatorcontrib>Garcia, Marcos Vinicius Fernandes</creatorcontrib><collection>PubMed</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of intensive care medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Nanah, Abdelrahman</au><au>Abdeljaleel, Fatima</au><au>Matsubara, Júlio Ken</au><au>Garcia, Marcos Vinicius Fernandes</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Outcomes and Practices of Endotracheal Intubation Using the Glasgow Coma Scale in Acute Non-Traumatic Poisoning: A Systematic Review and Meta-Analysis of Proportions</atitle><jtitle>Journal of intensive care medicine</jtitle><addtitle>J Intensive Care Med</addtitle><date>2024-08-16</date><risdate>2024</risdate><spage>8850666241275041</spage><pages>8850666241275041-</pages><issn>1525-1489</issn><eissn>1525-1489</eissn><abstract><![CDATA[Acute poisoning often results in decreased consciousness, necessitating airway assessment and management. Existing literature in the trauma setting suggests the importance of airway protection in unconscious patients to prevent complications, including aspiration. Practices for endotracheal intubation in non-traumatic acute poisoning are poorly described and variable, particularly regarding the use of a Glasgow Coma Scale (GCS) ≤ 8 threshold for intubation.
A systematic review and meta-analysis of proportions was conducted to evaluate intubation rates and outcomes in patients presenting for acute non-traumatic poisoning. Studies were excluded if the primary indication for intubation was not airway protection. We analyzed rates of intubation, mortality, and aspiration by subgrouping patients into GCS ≤ 8, GCS 9-15, or mixed GCS. Common and random-effects analysis were used, supplemented by subgroup analyses.
39 studies were included in the analysis, involving 15,959 patients. Random-effects pooled intubation rates varied significantly across GCS categories: GCS ≤ 8 (30.0%, I
= 92%, p < 0.01), GCS 9-15 (1.0%, I
= 0%, p = 0.91), and mixed GCS (11.0%, I
= 94%, p < 0.01), p-value <0.01 for subgroup difference. Aspiration rates also varied: GCS ≤ 8 (19.0%, I
= 84%, p < 0.01), GCS 9-15 (4.0%, I
= 78%, p < 0.01), and mixed group (5.0%, I
= 72%, p < 0.01), p-value <0.01 for subgroup difference. Mortality rates remained low across all groups: GCS ≤ 8 (1.0%, I
= 0%, p = 0.62), GCS 9-15 (1.0%, I
= 0%, p = 0.99), and mixed group (2.0%, I
= 68%, p < 0.01).
The conventional "less than 8, intubate" approach may not be directly applicable to acute poisoning patients due to heterogeneity in patient presentation, intubation practices, and low mortality. Therefore, a nuanced approach is warranted to optimize airway management strategies tailored to individual patient needs.]]></abstract><cop>United States</cop><pmid>39150325</pmid><doi>10.1177/08850666241275041</doi><orcidid>https://orcid.org/0000-0003-2633-7325</orcidid><orcidid>https://orcid.org/0009-0007-2934-9889</orcidid></addata></record> |
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| title | Outcomes and Practices of Endotracheal Intubation Using the Glasgow Coma Scale in Acute Non-Traumatic Poisoning: A Systematic Review and Meta-Analysis of Proportions |
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