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Incidence and risk factors of upper gastrointestinal bleeding in mechanically ventilated children

Jitladda Deerojanawong1, Danayawan Peongsujarit, Boosba Vivatvakin

  • 1Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand. jitladda@hotmail.com

Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies
|December 6, 2008
PubMed

Insights

Upper gastrointestinal (UGI) bleeding is common in mechanically ventilated children. Organ failure and high ventilator pressure are key risk factors for UGI bleeding in this vulnerable population.

Area of Science:

  • Pediatric Critical Care Medicine
  • Gastroenterology
  • Mechanical Ventilation

Background:

  • Upper gastrointestinal (UGI) bleeding is a potential complication in critically ill children.
  • Mechanical ventilation is frequently required for extended periods in pediatric intensive care units (PICUs).

Purpose of the Study:

  • To determine the incidence of UGI bleeding in children requiring mechanical ventilation for over 48 hours.
  • To identify factors associated with UGI bleeding in this patient group.

Main Methods:

  • Prospective analytic study conducted in a tertiary care pediatric intensive care unit.
  • 110 patients requiring mechanical ventilation >48 hours were monitored.
  • Data collected included demographics, diagnoses, ventilator settings, organ failure, and UGI bleeding events.

Main Results:

  • The incidence of UGI bleeding was 51.8%, with 3.6% experiencing clinically significant bleeding.
  • Univariate analysis identified thrombocytopenia, coagulopathy, organ failure, high ventilator pressure (≥25 cm H2O), and high PRISM score (≥10) as risk factors.
  • Multivariate analysis revealed organ failure (RR=2.85) and high ventilator pressure (RR=3.73) as independent risk factors.

Conclusions:

  • Upper gastrointestinal bleeding occurs frequently in pediatric patients requiring prolonged mechanical ventilation.
  • Organ failure and high-pressure mechanical ventilation settings are significant independent risk factors for UGI bleeding in these children.
Abstract

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