Incidence of Clinically Important Bleeding in Mechanically Ventilated Patients

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Abstract
The purpose of this study was to determine the incidence of clinically important gastrointestinal hemorrhage in mechanically ventilated patients, and to determine the risk factors for overt bleeding in this population. One hundred consecutive critically ill medical and surgical patients requiring mechanical ventilation for more than 48 hours were prospectively evaluated in a university-based tertiary care, medical/surgical intensive care unit. Seventyfour patients received stress ulcer prophylaxis. Overt bleeding occurred in nine paticnts (9.0%; 95% confidence interval [CI], 3.4-14.6%); eight of the nine patients had a coagulopathy. Clinically important bleeding occurred in two additional patients (2.0%; 95% CI, 0-6.2%). Multiple logistical regression analysis revcaled that only the presence of a coagulopathy (odds ratio 12.5; 95% CI, 3.4-46.5) and the presence of occult bleeding for six or more days (odds ratio 5.5; 95% CI, 1.2-25.4) were independently predictive of overt gastrointestinal hemorrhage. Sixteen patients died, two of whom had overt bleeding and one of whom had clinically important gastrointestinal bleeding. Clinically important gastrointestinal bleeding is uncommon in ventilated patients receiving stress ulcer prophylaxis. In the two patients who bled, both had peptic ulcer disease; one of these had stress ulceration. The presence of a coagulopathy is a powerful independent risk factor for overt bleeding in this population. The risk of overt bleeding also increases with the number of days of positive occult bleeding.