TITLE

Clinically Significant Gastrointestinal Bleeding in Critically Ill Patients in an Era of Prophylaxis

AUTHOR(S)
Pimentel, Mark; Roberts, Daniel E.; Bernstein, Charles N.; Hoppensach, Michael; Duerksen, Donald R.
PUB. DATE
October 2000
SOURCE
American Journal of Gastroenterology;Oct2000, Vol. 95 Issue 10, p2801
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
OBJECTIVE: Clinical studies examining stress-related gastro-intestinal bleeding in critically ill patients vary in their clinical definitions and assessment of clinical significance. Although there is evidence that routine prophylaxis decreases stress-related gastrointestinal bleeding, recent studies indicate a decreasing incidence, independent of the use of prophylactic medications. The purpose of this study was to determine the incidence of and risk factors for clinically significant, endoscopically proven gastrointestinal bleeding in critically ill patients. METHODS: A database (prospectively collected data) of 8338 patients admitted to the surgical and medical intensive care units at major tertiary care center from July 1988 to April 1995 was examined. All patients with significant upper gastrointestinal bleeding as defined by a drop in hemoglobin of >20 g/L and endoscopic evidence of an upper GI tract source were identified. Risk factors for GI bleeding from stress ulceration were compared in bleeding and nonbleeding patients. A case-control study analyzing risk factors for bleeding in the abdominal aortic aneurysm subgroup was performed. RESULTS: After exclusion criteria, 12/7231 (0.17%) patients had clinically significant, endoscopically proven bleeding. Significant risk factors included age, septic shock, abdominal aortic aneurysm repair, and nutritional support. Intensive care unit stay was prolonged in patients with stress-related bleeding. There was no difference in incidence of hypotension, clamp time, APACHE score, or operating room time in patients with abdominal aortic aneurysm repair as compared with controls. CONCLUSIONS: In an intensive care unit where stress prophylaxis is widely used, clinically important gastrointestinal bleeding is uncommon. Further study is needed to define the optimal prophylaxis regimen and the role for its selective use in high-risk patients.
ACCESSION #
17623994

 

Related Articles

  • Gastro-aortic fistula: An uncommon complication of nissen ... Wasvary, Harry; Surgery, Gary // American Surgeon;May1997, Vol. 63 Issue 5, p455 

    Presents a review of literature and a 69-year old male patient concerning primary gastro-aortic fistula secondary to erosion of a gastric ulcer into the thoracic aorta in a patient with a previous Nissen fundoplication. Major cause in the development of secondary fistula; Diagnosis of...

  • Primary aortoenteric fistula. Gelister, J. S. K.; Fox, J. A. // Journal of the Royal Society of Medicine;Jul1987, Vol. 80 Issue 7, p459 

    The article presents three case reports on primary aortoenteric fistula. Three older men have gastrointestinal hemorrhage with varying diagnoses. Based on the case reports, aortoenteric fistula may be spontaneous or may follow sortic graft operations. The diagnosis of primary aortoenteric...

  • Primary Aortoduodenal Fistula. Reiner, Mark A.; Brau, Salvador A.; Schanzer, Harry // American Journal of Gastroenterology;Sep1978, Vol. 70 Issue 3, p292 

    One hundred and twelve cases of primary aortoduodenal fistulas were reviewed, The most common etiological agent was an atherosclerotic infrarenal abdominal aortic aneurysm. There was a male to female predominance of 9:2 with an average age of 62 years. Most fistulas occurred between an...

  • Primary Aortoduodenal Fistula after Radiotherapy. Kalman, David R.; Barnard, Graham F.; Massimi, Gregory J.; Swanson, Richard S. // American Journal of Gastroenterology;Jul1995, Vol. 90 Issue 7, p1148 

    Primary aortoduodenal fistula is an uncommon cause of massive upper gastrointestinal hemorrhage; it is most commonly caused by the erosion of an abdominal aortic aneurysm into the third portion of the duodenum. This report describes a 73-yr-old man who developed uncontrollable hematemesis due to...

  • Critical gastrointestinal bleed due to secondary aortoenteric fistula. Malik, Mohammad U.; Ucbilek, Enver; Sherwal, Amanpreet S. // Journal of Community Hospital Internal Medicine Perspectives (JC;2015, Vol. 5 Issue 6, p1 

    Secondary aortoenteric fistula (SAEF) is a rare yet lethal cause of gastrointestinal bleeding and occurs as a complication of an abdominal aortic aneurysm repair. Clinical presentation may vary from herald bleeding to overt sepsis and requires high index of suspicion and clinical judgment to...

  • Monitoring Hemoglobin by Pulse Oximetry in the ICU: Is it Accurate and Safe? Pierson, David J. // Critical Care Alert;Sep2012, Vol. 20 Issue 6, p47 

    The article reports a study which found that total hemoglobin measured by pulse oximeter could not be determined in significant numbers of patients admitted to the intensive care unit (ICU) with acute gastrointestinal (GI) hemorrhage.

  • Bedside colonoscopy in intensive care units: indications, techniques, and outcomes. Church, James; Kao, Jeff // Surgical Endoscopy;Sep2014, Vol. 28 Issue 9, p2679 

    Background: Colonoscopy performed in critically ill patients is poorly documented in the literature. The clinical setting is completely different from routine outpatient colonoscopy with different aims and techniques. We proposed to examine the role of urgent colonoscopy in critically ill...

  • A Clinical Study of Acute Gastrointestinal Hemorrhage Associated with Various Shock States. Fusamoto, Hideyuki; Hagiwara, Hideki; Meren, Haruya; Kasahara, Akinori; Hayashi, Norio; Kawano, Sunao; Sugimoto, Tsuyoshi; Kamada, Takenobu // American Journal of Gastroenterology;Apr1991, Vol. 86 Issue 4, p429 

    Gastrointestinal hemorrhage from stress ulceration is a life-threatening complication in a critically ill patient. We retrospectively studied 471 patients admitted to the Department of Traumatology of our hospital who developed shock in their clinical course. Forty-two patients (8.9%) developed...

  • A mobile Meckel! El-Matary, Wael; Roseman, David; Lees, Gordon; Maguire, Conor // European Journal of Pediatrics;Dec2009, Vol. 168 Issue 12, p1525 

    A technetium-99m pertechnetate Meckel scan is the standard diagnostic test to diagnose Meckel diverticulum. Although a negative scan does not exclude Meckel diverticulum, it should be kept in mind that the diagnosis can be missed on the basis of a single negative scan. Another important point is...

Share

Read the Article

Courtesy of VIRGINIA BEACH PUBLIC LIBRARY AND SYSTEM

Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics