PURPOSE: Many patients admitted to the intensive care unit have been reported to develop gastrointestinal hemorrhage and low hemoglobin. The incidence ranges from 3.4% to 52.7%. Previous studies have shown that these patients have a less favorable outcome. We performed a study to access whether patients who developed gastrointestinal bleed while in the ICU, and received gastrointestinal endoscopy, had any change in management.
METHODS: We retrospectively investigated 110 ICU patients over 13 months who had a gastrointestinal endoscopy during their ICU stay in a 440-bed teaching hospital. Thirty-six were admitted for reasons other than gastrointestinal bleeding. The patients were assessed for risk factors leading to clinically important bleeding (Table 1), APACHE II score, and interventions that occurred as a result of the endoscopy.
RESULTS: Patients evaluated had a mean APACHE II score of 19 ±6 and a mean INR of 1.5. Eighty seven percent of the patients received stress related mucosal disease prophylaxis with proton pump inhibitors or H2 blockers at the time of the gastrointestinal bleeding. One hundred percent of patients received anticoagulation,(25% were on therapeutic anticoagulation therapy)and 86% patients required blood transfusion. (Table 2) Only one patient had a hemostatic procedure as a result of gastrointestinal endoscopy (2.7%).
CONCLUSION: 1 out of 36 patients (2.7%) admitted for reasons other than gastrointestinal bleeding had an intervention during ICU stay as a result of the endoscopy compared to 20–50% of patients admitted primarily for GI bleeds who eventually receive intervention. As a result of these findings, we can infer that a great number of patients who develop GI bleeds in the ICU can be managed conservatively without invasive endoscopic investigation.
CLINICAL IMPLICATIONS: Despite the frequency with which gastrointestinal bleeds occur while in the ICU, patients seldom develop clinically significant bleeds that require invasive therapy. Critically ill patients who develop gastrointestinal bleeding without prior history may not benefit from gastrointestinal endoscopy in the ICU.
DISCLOSURE: Jay Nfonoyim, None.