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Risk factors for gastrointestinal bleeding in critically ill patients. Canadian Critical Care Trials Group
D J Cook1, H D Fuller, G H Guyatt
1Faculty of Health Sciences, McMaster University, Hamilton, Ont., Canada.
The New England Journal of Medicine
|February 10, 1994
Summary
Prophylaxis against stress ulcers is widely used but has risks. This study found that critically ill patients without respiratory failure or coagulopathy rarely experience significant gastrointestinal bleeding.
Area of Science:
- Critical Care Medicine
- Gastroenterology
- Pharmacology
Background:
- Stress ulcer prophylaxis is common in critically ill patients to prevent gastrointestinal bleeding.
- However, side effects and costs necessitate identifying patients who truly benefit from prophylaxis.
Purpose of the Study:
- To identify risk factors for clinically important gastrointestinal bleeding in critically ill patients.
- To determine which patients are most likely to benefit from stress ulcer prophylaxis.
Main Methods:
- Prospective multicenter cohort study.
- Evaluated risk factors for stress ulceration in intensive care unit (ICU) patients.
- Documented clinically important gastrointestinal bleeding (overt bleeding with hemodynamic compromise or transfusion).
Main Results:
- Clinically important bleeding occurred in 1.5% of 2252 patients.
- Independent risk factors for bleeding were respiratory failure (OR, 15.6) and coagulopathy (OR, 4.3).
- Bleeding rates were 3.7% in patients with risk factors vs. 0.1% in those without.
Conclusions:
- Clinically important gastrointestinal bleeding is infrequent in critically ill patients.
- Prophylaxis can be withheld unless patients have coagulopathy or require mechanical ventilation.
- Targeting prophylaxis reduces unnecessary medication exposure and costs.