Early Intensive Resuscitation of Patients With Upper Gastrointestinal Bleeding Decreases Mortality

Evolución en la epidemiología de la hemorragia digestiva alta no varicosa desde el año 1985 hasta 2006

“…La edad es un factor de mal pronóstico en la evolución del HDA, aceptado por la mayoría de los autores. La hemorragia digestiva alta grave se suele presentar con más frecuencia en ancianos, estos suelen tener más comorbili-dades médicas: cardiorrespiratorias, renales y/o vasculares, que normalmente se descompensan tras este cuadro agudo (9,10,(16)(17)(18)(19).…”

“…Así, la mayor parte de las muertes no ocurre por la hemorragia digestiva en sí, sino por las descompensaciones de la patología de base que padecen, o por las complicaciones postoperatorias que se presentan, de una forma mucho más frecuente en este grupo de pacientes (10,(14)(15)(16)(17)(18).…”

Upper Gastrointestinal Bleeding: Etiologies and Management

“…Early correction of hemodynamics, hematocrit level, and coagulopathy with aggressive fluid resuscitation should be performed because this substantially decreases mortality. 13 Blood transfusion should be considered for most patients when the hemoglobin level is less than 7 g/dL, although a higher transfusion threshold may be necessary for patients with unstable coronary artery disease or active, ongoing bleeding. 14 Platelet transfusion should be administered to patients with active bleeding and a platelet count less than 50,000Â10 3 /mL (to convert to Â10 9 /L, multiply by 1).…”

A Sampling of Canadian Practice in Managing Nonvariceal Upper Gastrointestinal Bleeding before Recent Guideline Publication: Is there Room for Improvement?

“…If patients manifested symptoms or signs of hemodynamic instability, they were appropriately treated faster and received more aggressive IV resuscitation. Recently, aggressive resuscitation has been shown to improve outcomes (30). Despite a recent finding from the RUGBE study that the nasogastric aspirate provides valuable clinical information in predicting high-risk lesions (23), it was not used very often.…”