Frequency of upper gastrointestinal bleeding in a pediatric intensive care unit

Lacroix, Jacques; Nadeau, Daniel; Laberge, Sophie; Gauthier, Marie; Lapierre, G.; Farrell, Catherine

doi:10.1097/00003246-199201000-00013

Cited by 94 publications

(44 citation statements)

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“…5 A prospective Canadian study conducted in a PICU within a university hospital, detected UGIB in 63 of 984 children (6.4%), but only 0.4% had a clinically significant outcome, for example, hypotension, death, or transfusion occurring within 24 hours after the bleeding episode. 9 In this study 43% were female and their mean age was 5.3 years. 9 The highest frequency of developing UGIB (69.8%) occurred within the first 72 hours of admission to the PICU.…”

Section: Epidemiologymentioning

confidence: 61%

Diagnosis and Management of Upper Gastrointestinal Bleeding in Children

Owensby

Taylor

Wilkins

2015

The Journal of the American Board of Family Medicine

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Upper gastrointestinal bleeding is an uncommon but potentially serious, life-threatening condition in children. Rapid assessment, stabilization, and resuscitation should precede all diagnostic modalities in unstable children. The diagnostic approach includes history, examination, laboratory evaluation, endoscopic procedures, and imaging studies. The clinician needs to determine carefully whether any blood or possible blood reported by a child or adult represents true upper gastrointestinal bleeding because most children with true upper gastrointestinal bleeding require admission to a pediatric intensive care unit. After the diagnosis is established, the physician should start a proton pump inhibitor or histamine 2 receptor antagonist in children with upper gastrointestinal bleeding. Consideration should also be given to the initiation of vasoactive drugs in all children in whom variceal bleeding is suspected. An endoscopy should be performed once the child is hemodynamically stable. (J Am Board Fam Med 2015; 28:134 -145.)

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Section: Epidemiologymentioning

confidence: 61%

Diagnosis and Management of Upper Gastrointestinal Bleeding in Children

Owensby

Taylor

Wilkins

2015

The Journal of the American Board of Family Medicine

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“…Our review of then literature showed that only two prior studies provided information on the prevalence of SU prophylaxis in children; these reported prevalence rates of 11 and 14.5% respectively, with use of prophylaxis restricted to high-risk patients. 5,6 No pediatric studies on SRMD prophylaxis have been conducted in Brazil. The only investigation on the subject conducted in the country was carried out in an adult ICU, and reported that 73.5% of patients received SU prophylaxis -a rate very similar to that found in the present study.…”

Section: Discussionmentioning

confidence: 99%

“…2,5,6,17 The incidence of clinically important (major) upper gastrointestinal bleeding is so low in patients with one or no risk factors (0.1%) that SU prophylaxis would be entirely unwarranted in this group; it has been suggested that prophylaxis be indicated only in patients with two out of these three risk factors. 6 Mechanical ventilation was clearly regarded as a major indication for prophylaxis by the physicians in our sample;…”

Section: Discussionmentioning

confidence: 99%

“…3 Stress ulcer prophylaxis in pediatric intensive care units Taisa E. Araujo, 1 Sandra M. G. Vieira, 2 Paulo R. A. Carvalho 3 Several studies have suggested that mechanical ventilation (MV) is one of the most significant of various probable risk factors for this condition, both in adults and children admitted to intensive care. [4][5][6] A study by Chaïbou et al found three independent risk factors for major upper gastrointestinal bleeding in critically ill children: respiratory failure [odds ratio (OR) = 10.2], coagulopathy (OR = 9.3), and a pediatric risk of mortality (PRISM) score ≥ 10 (OR = 4.0). 6 The PRISM score assesses several clinical and laboratory parameters and is used to predict mortality in the pediatric intensive care unit (PICU) environment.…”

Section: Introductionmentioning

confidence: 99%

“…Most studies date back to the 1990s, and none have been conducted in Brazil. 5,6 SU prophylaxis has been associated with major complications, such as hospital-acquired pneumonia, particularly in critically ill patients. 8 Establishing a profile of SU prophylaxis administration in a certain population is therefore an important part of any thorough review of the appropriateness of this intervention.…”

Section: Introductionmentioning

confidence: 99%

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Profilaxia para úlcera de estresse em pacientes internados em UTI pediátrica

Araújo¹,

Vieira²,

Carvalho³

2010

J. Pediatr. (Rio J.)

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Objective: To assess use of stress ulcer prophylaxis in patients admitted to five pediatric intensive care units (PICUs) in Porto Alegre, Brazil.Methods: This was a multicenter, prospective, cross-sectional observational study. PICUs were visited on randomly defined days between April 2006 and February 2007, and the medical records of admitted patients were reviewed. Patients whose records had been previously assessed were excluded, as were those with upper gastrointestinal bleeding on admission. Data were collected on age, gender, admission diagnosis, severity of illness, administration of stress ulcer prophylaxis, rationale for prophylaxis, and first-line prophylactic agent of choice. Variables were described as absolute and relative frequencies, mean and standard deviation, or median and interquartile range as appropriate. Pearson's chi-square test for linear trend or Fisher's exact test were used to assess possible associations. The level of significance was set at 5% (p ≤ 0.05).Results: 398 patients (57% male) were assessed [median age, 16 months (IQR 4-65); median length of PICU stay, 4 days (IQR 1-9)]. Respiratory illness was the main reason for admission (32.7%). Most patients received stress ulcer prophylaxis (77.5%; range, 66-91%). Mechanical ventilation (22.3%) was the most common rationale provided, followed by informal routine use of prophylaxis (21.4%). Only one of the participating PICUs had a specific care protocol for use of stress ulcer prophylaxis. Ranitidine was the most commonly used drug (84.5% of cases). Evidence of minor gastrointestinal bleeding was found in 3% of patients; none had clinically significant bleeds. Conclusions:Administration of stress ulcer prophylaxis is a common practice in the participating PICUs, with ranitidine the most commonly used drug. Among the various rationales provided, mechanical ventilation and informal routine use were the most prevalent.J Pediatr (Rio J). 2010;86(6):525-530: Gastroduodenal ulcer, prophylaxis, children, intensive care, gastrointestinal bleeding.

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