Despite advances in diagnostic and therapeutic endoscopy, the mortality of patients with upper gastrointestinal bleeding (UGIB) has remained relatively constant.
Inadequate early resuscitation is believed to be a major factor in the persistently high mortality rate in patients with UGIB.
In this study, doctors from New York evaluated he role of intensive resuscitation in the outcome of patients with UGIB.
The team enrolled 72 consecutive patients with UGIB complicated by hemodynamic instability related to bleeding in the study.
They followed an initial cohort of 36 patients (observation group) to collect data.
The team recorded demographic information, the time interval between presentation with UGIB and the correction of hemodynamic instability, hematocrit (HCT), and coagulopathy.
|The intensive resuscitation group had a shorter time interval from admission to stabilization.|
|American Journal of Gastroenterology|
They also recorded any medical treatment, endoscopic intervention, as well as the patients' outcome.
The team prospectively followed a second cohort of 36 patients (intensive resuscitation group).
Again, demographic and outcome data was collected, however, the physicians involved in collecting the data also provided guidance to the health care team managing the patients.
The doctors found that there were no significant differences with regard to age, gender, number and type of comorbid diseases, history of prior GI bleeding, or etiology of bleeding between the 2 groups.
However, they found that patients in the intensive resuscitation group had a significant decrease in the time from admission to stabilization of hemodynamics and correction of HCT.
The team determined that there was no significant difference in the time interval from admission to endoscopic intervention, length-of-stay, or the number of units of blood given.
Overall, fewer patients in the intensive resuscitation group suffered myocardial infarction.
Furthermore, the team found that mortality was significantly lower in the intensive resuscitation group compared to the observational group.
Dr Robin Baradarian's team concluded, "Early intensive resuscitation of patients with upper gastrointestinal bleeding significantly decreases mortality".
"Physicians involved in the care of patients with UGIB should focus on early and rapid correction of hemodynamics, HCT, and underlying coagulopathy".