Resuscitation and monitoring in gastrointestinal bleeding

Kilic, Yakup; Konan, Ali; Kaynaroğlu, Volkan

doi:10.1007/s00068-011-0113-6

Cited by 6 publications

(2 citation statements)

References 70 publications

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“…The clinical examination and vital signs commonly used in the setting of GI bleeding, such as blood pressure, heart rate, hypothermia, and oxygen saturation, are ineffective markers of blood loss, but yet they are the main items in hemodynamic assessments for the most common GI bleeding risk predictive scores, clearly because of their availability and noninvasive nature. There is growing evidence demonstrating the usefulness of US in patients’ volume status assessments, improving and changing clinical management of patients with hypovolemia.…”

Section: Discussionmentioning

confidence: 99%

Results of a Prospective Study to Evaluate the Impact of Point‐of‐Care Ultrasound in the Enhancement of Gastrointestinal Bleeding Risk Scores

Tung‐Chen

Gómez-Casero

Díaz

et al. 2019

J of Ultrasound Medicine

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Objectives Gastrointestinal (GI) bleeding is a common illness seen in the emergency department. The prognosis varies from self‐limited to potentially life threatening. Currently available GI bleeding risk scores have only a modest predictive value, limiting their wide implementation. The aim of this study was to assess the association and capability of point‐of‐care ultrasound (POCUS) used by emergency physicians to improve common GI bleeding scores for predicting complications and long‐term outcomes of patients with GI bleeding, which to our knowledge have never been studied. Methods Between August 2015 and April 2017, 203 hemodynamically stable patients with acute GI bleeding admitted to the emergency department were prospectively investigated. Using ultrasound, we measured the inferior vena cava diameter, cardiac output with surrogate markers such as the velocity time integral before and after the passive leg‐raising test, and the presence of systolic obliteration of the left ventricle. The Rockall and Glasgow‐Blatchford scores were calculated for patients with upper GI bleeding and the Velayos score for lower GI bleeding. The patients had follow‐up during hospitalization and 30 days later to assess for early and late adverse events (AEs). Then we integrated the ultrasound findings of hypovolemia into the GI bleeding scores, assessing the capability to detect AEs. Results In our cohort, patients with upper GI bleeding who showed left ventricle kissing walls had a worse evolution, with a greater presence of late AEs (odds ratio [OR], 3.8; 95% confidence interval [CI], 1.32–10.96; P = .01). Patients with lower GI bleeding who showed a collapse of the inferior vena cava (>50%) after passive leg raising had a greater presence of early AEs (OR, 3.6; 95% CI, 1.46–9.00; P = .004). The predictive performance of the Rockall score (receiver operating characteristic analysis: area under the curve [AUC], 77.6%; 95% CI, 66.3%–88.8%) increased with POCUS (AUC, 80.3%; 95% CI, 69.5%–91.1%); that of the Glasgow‐Blatchford score (AUC, 72.5%; 95% CI, 59.9%–85.2%) increased with POCUS (AUC, 73.2%; 95% CI, 61.1%–85.4%); and that of Velayos score (AUC, 55.7%; 95% CI, 42.5%–69.0%) also increased with POCUS (AUC, 72.2%; 95% CI, 61.1%–83.3%). Conclusions The use of POCUS in GI bleeding is feasible and enhances common GI bleeding risk scores, showing better predictive performance in detecting AEs.

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Section: Discussionmentioning

confidence: 99%

Results of a Prospective Study to Evaluate the Impact of Point‐of‐Care Ultrasound in the Enhancement of Gastrointestinal Bleeding Risk Scores

Tung‐Chen

Gómez-Casero

Díaz

et al. 2019

J of Ultrasound Medicine

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“…However, these advances in resuscitation and monitoring have not yet been fully adapted to the management of gastrointestinal bleeding [1]. Resuscitation of severe gastrointestinal bleeding requires a delicate balance that maintains appropriate end organ perfusion to prevent organ failure while avoiding the complications of aggressive resuscitation which may increase hemorrhage and mortality in uncontrolled hemorrhage.…”

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confidence: 99%