Management by the intensivist of gastrointestinal bleeding in adults and children

Abstract

Intensivists are regularly confronted with the question of gastrointestinal bleeding. To date, the latest international recommendations regarding prevention and treatment for gastrointestinal bleeding lack a specific approach to the critically ill patients. We present recommendations for management by the intensivist of gastrointestinal bleeding in adults and children, developed with the GRADE system by an experts group of the French-Language Society of Intensive Care (Société de Réanimation de Langue Française (SRLF), with the participation of the French Language Group of Paediatric Intensive Care and Emergencies (GFRUP), the French Society of Emergency Medicine (SFMU), the French Society of Gastroenterology (SNFGE), and the French Society of Digestive Endoscopy (SFED). The recommendations cover five fields of application: management of gastrointestinal bleeding before endoscopic diagnosis, treatment of upper gastrointestinal bleeding unrelated to portal hypertension, treatment of upper gastrointestinal bleeding related to portal hypertension, management of presumed lower gastrointestinal bleeding, and prevention of upper gastrointestinal bleeding in intensive care.

Management of upper gastrointestinal bleeding in emergency departments, from bleeding symptoms to diagnosis: a prospective, multicenter, observational study

“…Several recommendations regarding UGB management have been published, including therapeutic interventions initiated by the emergency physicians. The implementation of these recommendations could affect patients’ prognosis [ 2 , 7 , 8 ].…”

A Review on Clinical, Pathophysiological, and Diagnostic Hematological Features in Children With Liver Cirrhosis

“…98 Managemental measures in cirrhotic children at the risk of bleeding generally fall into correcting coagulopathy through vitamin K infusion, the administration of vasoconstrictors, and blood product transfusion. 99,100 Although the beneficial role of H2-receptor antagonists is noticeable in preventing gastrointestinal bleeding in cirrhotic children, the clinical applicability of these therapeutics in the prevention of bleedings in cirrhosis is under debate. 101 Hyperfibrinolysis is a condition in which fibrin degradation exceeds its polymerization which is partly involved in bleeding diatheses.…”

Transfusion de concentrés globulaires en réanimation : moins, c’est mieux !

“…L'applicabilité de ces résultats aux patients de réanimation est néanmoins sujette à caution car la plupart des patients inclus ne présentaient pas d'instabilité hémodynamique et que la présence d'un saignement massif était un critère de non-inclusion dans l'étude [49]. Pour autant, cette étude récente vient appuyer les recommandations d'experts préalablement publiées en faveur d'une stratégie transfusionnelle restrictive, particulièrement lorsque l'hémorragie digestive est secondaire à une hypertension portale [50,51].…”