Respiratory complications in critically ill medical patients with acute upper gastrointestinal bleeding.
OBJECTIVE
To determine types of respiratory complications encountered in critically ill patients with serious acute upper gastrointestinal (GI) bleeding, and to identify associated risk factors.


METHODS
Retrospective chart review.


METHODS
A university hospital medical ICU.


METHODS
We reviewed medical records of 86 patients admitted to the medical ICU over a 2 1/2-yr period of time, for 107 consecutive episodes of serious acute upper GI bleeding. Clinical features of patients who developed respiratory complications of pneumonia, witnessed aspiration of gastric contents, or who required intubation and mechanical ventilation for other reasons were compared with those features of patients without respiratory complications.


RESULTS
Respiratory complications occurred during 23 (22%) serious upper GI bleeding episodes (mean transfusion requirement, 7 units of packed RBCs). Twelve patients developed pneumonia and all had evidence of advanced liver disease. Five patients were observed to aspirate gastric contents and six patients require intubation and mechanical ventilation for reasons other than pneumonia or aspiration. Esophageal sites of bleeding (esophagitis, esophageal ulcers and esophageal varices), advanced liver disease, age greater than 70 yrs, and an Acute Physiology and Chronic Health Evaluation (APACHE) II score greater than 13 appeared to be risk factors. Mortality rate was increased in patients with respiratory complications: 70% of patients with respiratory complications died, compared with 4% of those patients without such problems (p less than .001).


CONCLUSIONS
Respiratory complications are common in critically ill medical patients with serious acute upper GI bleeding, and are associated with a poor outcome. Risk factors include advanced liver disease, esophageal site of bleeding, age greater than 70 yrs, and higher APACHE II score.
Liebler
J M
JM
Department of Medicine, Oregon Health Sciences University, Portland 97201.
Benner
K
K
Putnam
T
T
Vollmer
W M
WM
D000208:Acute Disease; D000328:Adult; D000368:Aged; D003422:Critical Care / Q000706:statistics & numerical data; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000150:complications* / Q000453:epidemiology / Q000401:mortality; D006801:Humans; D007441:Intubation, Gastrointestinal / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009922:Oregon / Q000453:epidemiology; D011014:Pneumonia / Q000453:epidemiology / Q000209:etiology / Q000401:mortality; D011015:Pneumonia, Aspiration / Q000453:epidemiology / Q000209:etiology / Q000401:mortality; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D012140:Respiratory Tract Diseases / Q000453:epidemiology / Q000209:etiology* / Q000401:mortality; D012189:Retrospective Studies