Upper gastrointestinal bleeding in mechanically ventilated patients in medical ICU: A single-center study

 

Fig 1: Causes of upper GIT bleeding in mechanically ventilated patients A: gastric ulcer B: Portal hypertensive gastropathy C: Black esophagus with a blackish necrotic surface. D: candida esophagitis with whitish membranes and superficial ulcers.

Ashraf Khalifa Elnagar, MD, Amr Shaaban Hanafy, MD, Ahmed I. Alagrody, MD

Department of Internal Medicine, Faculty of Medicine, Zagazig University, Egypt

Running Head: gastrointestinal bleeding in ventilated patients

Corresponding author

Dr. Amr Shaaban Hanafy

Internal medicine department, Hepatogastroenterology section – Zagazig University.

Dr_amr_hanafy@yahoo.com/amrhanafy@zu.edu.eg.

Sharkia- Zagazig- Egypt. Postal code: 44519.

40-Mostafa Fouad St.

Cell: +201100061861.

amrhanafy@zu.edu.eg.

- Number of words: 3000, excluding (title page, abstracts, and references).

- Number of figures (1) and tables (4).

Authors' contribution: Elnagar AK was the guarantor, Elnagar AK and Alagrody AI made the study concept, and design, Elnagar AK and Alagrody AI participated in the acquisition, analysis, interpretation of the data, and drafted the initial manuscript. A Hanafy, Alagrody AI performed an endoscopic examination. All authors revised the article for important intellectual content.

DOI:10.21608/ajgh.2022.151761.1008

Type of manuscript: original research.

Conflict of interest: N / A

Funding source: This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Date of submission: 21 July 2022.

Revised: 5, August 2022.

Accepted: 30 August 2022.

First online: 10 September 2022.

Abstract

Aims

Upper Gastrointestinal bleeding (UGIB) in critically ill patients under mechanical ventilation (MV) is a significant cause of morbidity and mortality. Therefore, it aimed to study the incidence, predictors, and etiology of UGIB in critically ill patients under MV.

Patients and Methods

Three hundred and sixty critically ill patients were managed by mechanical ventilation. The patients were evaluated by complete clinical examination, APACHE II score, liver and kidney function tests, and abdominal ultrasound. In addition, upper gastrointestinal endoscopy was done for survived patients with UGIB during MV after weaning with a stable clinical condition for at least 48 hours.

Results

41 patients (11.4 %) had UGIB; 15 patients (36.6%) survived and death occurred in 26 (63.4%). Upper endoscopy revealed large ulcers > 2 cm in the gastric antrum (n=1), multiple antral ulcers (n=2), large >2cm corporeal gastric ulcers (n=2) [all were Forrest Ib with oozing surface], bleeding small duodenal bulb ulcers < 2cm (n=1) [Forrest Ia with spurting], small ulcers in the lower esophagus with lower end esophagitis (n=2), black esophagus (n=1), ulcer on top of grade III oesophageal varices (n=2), severe portal hypertensive gastropathy (n=3), candida esophagitis and gastritis (n=1). Logistic regression analysis revealed that the independent variables of UGIB were elevated serum creatinine, APACHE II score >14, peak inspiratory pressure ≥ 30cmH2O, and prolonged aPTT.

Conclusions

Mechanically ventilated patients had a high risk of upper gastrointestinal bleeding, which the postulated parameters can predict for adequate prophylaxis.