Risk factors for significant upper gastrointestinal bleeding in patients requiring mechanical ventilation

ABSTRACT Stress ulcers commonly occur in critically ill patients. Significant gastrointestinal bleeding occurs in some of these patients. This study was conducted to evaluate the incidence and risk factors for clinically important upper gastrointestinal bleeding in critically ill, mechanically ventilated patients. Our patients were selected from internal wards (respiratory, renal, general, Infectious), neurology and intensive care units (ICUs) in Imam Khomeini hospital of Tabriz, Iran. In this prospective study 300 critically ill and mechanically ventilated patients which had been admitted for surgical wards or ICUs were studied during 2002-2003. Significant upper gastrointestinal bleeding was diagnosed in our patients studied and risk factors were compared in bleeding and non bleeding ones. Clinically important upper gastrointestinal bleeding occurred in 80 patients (26.7%). In 65% of patients bleeding episodes occurred in the first 2 weeks of hospital stay. Sex and age of patients could not predict the bleeding. The highest incidence of gastrointestinal bleeding was observed in patients with sepsis(44.4%), renal failure (33.3%) and central nervous system (32.2%). It was concluded that, renal failure, dysfunction of pulmonary and cardiovascular system and coagulopathy were all associated with an increased risk of clinically important gastrointestinal bleeding in critically ill ventilated patients.