Intensive care management of upper gastrointestinal bleeding in children: A review

Abstract

Managing children having an upper gastrointestinal bleed (UGIB) can be anxiety-provoking for an intensivist, as the differential diagnosis can vary from a benign disorder to a life-threatening condition, with the potential for high fatality if the management is delayed. Common causes in children of UGIB as a presenting complaint in the emergency department include mucosal lesions and variceal hemorrhage. While in intensive care settings, UGIB is usually secondary and is common in critically sick children with risk factors like respiratory failure, shock, organ failure and trauma. Despite the varied presentation, the primary focus in a child with UGIB is resuscitation and stabilization followed by a diagnostic evaluation. Pharmacological methods in management of UGIB include vitamin K, acid suppression agents while patients with portal hypertension warrant special consideration where splanchnic vasoconstrictors may have a role. Emergency endoscopy in acute UGIB in children can be technically difficult and risky to the patient, and it must be performed only once the patient is adequately stabilized. In this review, an attempt has been made to discuss an intensivist approach to UGIB in children.

Keywords

• bleeding
• gastrointestinal
• pediatrics
• acute
• portal hypertension