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The rate of gastrointestinal bleeding in a general ICU population: a retrospective study
Insights
This study evaluated gastrointestinal bleeding prevention protocols for intensive care unit (ICU) patients. Results show that while protocols are effective, the enteral feeding group had significantly higher bleeding rates, suggesting a need for protocol refinement.
Area of Science:
- Critical Care Medicine
- Gastroenterology
- Pharmacology
Background:
- Gastrointestinal bleeding is a significant risk for intensive care unit (ICU) patients.
- Standardized protocols are used to prevent stress-related gastrointestinal bleeding in critically ill patients.
Purpose of the Study:
- To evaluate the effectiveness of a specific protocol for preventing gastrointestinal bleeding in ICU patients.
- To compare the incidence of gastrointestinal bleeding across different components of the prevention protocol.
Main Methods:
- Retrospective review of 298 patient charts.
- Analysis of gastrointestinal bleeding rates in patients receiving antacids, intravenous cimetidine, or both.
- Comparison of bleeding rates in patients where the protocol was stopped due to enteral feeding.
Main Results:
- The incidence of gastrointestinal bleeding varied significantly across groups: 5% (antacid), 15% (cimetidine), 25% (both), and 56% (enteral feeding).
- Groups were homogenous for age and risk factors, indicating protocol variations influenced bleeding rates.
- Stopping the protocol for enteral feeding was associated with a substantially higher bleeding risk.
Conclusions:
- Treatment protocols are crucial for preventing gastrointestinal bleeding in high-risk ICU patients.
- The current protocol's effectiveness may be compromised by enteral feeding, necessitating further investigation and potential modifications.
- Differences in bleeding rates highlight the importance of optimizing prophylactic strategies in critical care settings.
Abstract:
We retrospectively reviewed 298 charts in order to evaluate the efficiency of a protocol used to prevent gastrointestinal bleeding among ICU patients. The protocol included the use of an antacid (186 patients), iv administration of cimetidine (66 patients), or both drugs when the combination was needed because of a persistently low gastric pH after antacid (28 cases). In 18 cases the implementation of this protocol was stopped when enteral feeding through a nasogastric tube was started. All four groups were homogenous for average age and the presence of risk factors at admission as well as at the time of bleeding. Nevertheless the percentage of gastric bleeding during ICU stay (coffee-ground vomitus haematemesis and/or melaena) widely varied: 5% for the antacid group; 15% in the cimetidine group; 25% in the "both" group and 56% in the "enteral" group. Possible explanations for these differences are discussed. The results support the use of treatment protocols in order to prevent gastrointestinal bleeding in patients with risk factors who are admitted to ICU.