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Fixed Volume or Fixed Pressure: A Murine Model of Hemorrhagic Shock
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Risk Under Pressure: Gastrointestinal Bleeding in Critically Injured Trauma Patients.

Stacey N Lynch1, Maici Craig2, George Michael2

  • 1From the Division of Trauma/Surgical Critical Care, University of Tennessee Health Science Center, Memphis, TN (Lynch, Byerly, Filiberto).

Journal of the American College of Surgeons
|September 9, 2025
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Summary
This summary is machine-generated.

Gastrointestinal bleeding (GiB) affects critically ill trauma patients. Male sex, vasopressor use, and renal replacement therapy are key risk factors for GiB in this population.

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Area of Science:

  • Critical Care Medicine
  • Trauma Surgery
  • Gastroenterology

Background:

  • Gastrointestinal bleeding (GiB) is a known complication in critical care, linked to hypoperfusion and mucosal barrier dysfunction.
  • While risk factors for GiB are studied in general populations, they are less understood in critically ill trauma patients.
  • This study focuses on the incidence and specific risk factors for GiB in trauma intensive care unit (TICU) patients.

Purpose of the Study:

  • To determine the incidence of GiB in critically ill trauma patients.
  • To identify independent risk factors associated with GiB in this specific patient cohort.
  • To inform preventive strategies for GiB in trauma critical care.

Main Methods:

  • Retrospective analysis of patients admitted to a level 1 trauma center's TICU from March 2019 to July 2023.
  • Inclusion criteria: mechanical ventilation for > 48 hours.
  • Case-control analysis (1:3 matching by age) comparing GiB patients with controls, using conditional logistic regression to identify predictors.

Main Results:

  • A total of 2,289 patients were reviewed, with 64 identified as having GiB (48 clinically significant).
  • Independent predictors for GiB included male sex (AOR=3.12), vasopressor use (AOR=3.16), corticosteroid use (AOR=2.45), need for renal replacement therapy (AOR=3.54), and enteral nutrition intolerance (AOR=3.86).
  • The overall trauma population had a median age of 41, Injury Severity Score of 22, and a mortality rate of 21%.

Conclusions:

  • Gastrointestinal bleeding remains a significant concern in critically ill trauma patients.
  • Identifying unique risk factors in this population is crucial for earlier detection and targeted preventive measures.
  • Further research can lead to improved GiB incidence reduction strategies in trauma critical care settings.