Incidence and risk factors of upper gastrointestinal bleeding in mechanically ventilated children

Objective: To identify the incidence and factors related to upper gastrointestinal (UGI) bleeding in children requiring mechanical ventilation for longer than 48 hrs. Design: Prospective analytic study. Setting: Ten-bed-pediatric intensive care unit of a tertiary care University Hospital. Patients: A total of 110 patents requiring mechanical ventilation for longer than 48 hrs from January 1, 2005 to December 31, 2005. Measurements and Results: UGI bleeding was defined by evidence of blood in nasogastric aspirates, hematemesis, or melena within 5 days of pediatric intensive care unit admission. We prospectively collected data on patient demographics, admission diagnosis, operative status, and pediatric risk of mortality score. UGI bleeding and the potential risk factors including organ failure, coagulopathy, maximum ventilator setting, enteral feeding, stress ulcer prophylaxis as well as sedation were daily monitored. Of the 110 patients who required mechanical ventilation for >48 hrs, the incidence of UGI bleeding was 51.8%, in which 3.6% of the cases presented with clinically significant bleeding (shock, requiring blood transfusion and/or surgery). Significant risk factors were thrombocytopenia, prolonged partial thromboplastin time, organ failure, high pressure ventilator setting >= 25 cm H2O, and pediatric risk of mortality score >= 10 using univariate analysis. However, the independent factors of UGI bleeding in the multivariate analysis were organ failure (relative risk = 2.85, 95% confidence interval 1.18-6.92) and high pressure ventilator setting = >= 25 cm H2O (relative risk = 3.73, 95% confidence interval 1.59-8.72). Conclusion: The incidence of UGI bleeding is high in children requiring mechanical ventilation. Organ failure and high pressure ventilator setting are significant risk factors for UGI bleeding. (Pediatr Crit Care Med 2009; 10:91-95)