Low incidence of hemodynamic instability in patients with gastrointestinal hemorrhage

Patients with gastrointestinal hemorrhage are frequently admitted to critical care units, in large part to be observed for signs of hemodynamic instability. All patients admitted with gastrointestinal bleeding to our medical intensive care unit over a 1-year period (n=108) were retrospectively reviewed to determine the incidence of hemodynamic instability. In an elderly patient population with predominantly nonvariceal bleeding, only 13% of those admitted had documented hypotension that led to an intervention. Only 7% had clinically significant hypotension after the first 5 hours of admission. Admission clinical criteria were analyzed by multivariate analysis but could not reliably predict patients at increased risk for hemodynamic instability. However, patients without significant comorbid illness who have been endoscopically shown to have a low-risk lesion can be considered for early transfer to a regular bed after a short period of close observation. This could lead to better resource utilization and cost savings without jeopardizing patient care.