Gastroenterology Critical Care

Overview

Pratt DS, Epstein SK. Recent advances in critical care gastroenterology.  Am J Respir Crit Care Med. 2000; 161:1417-20. Excellent update focusing on approaches to the management of acute variceal hemorrhage, acute colonic pseudo-obstruction, and severe necrotizing pancreatitis. http://www.ncbi.nlm.nih.gov/pubmed/10806132?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

Gastrointestinal Bleeding/Anemia

Cook DJ, Fuller HD, Guyatt GH, et al. Risk factors for gastrointestinal bleeding in critically ill patients. N Engl J Med 1994;330:377-81. Study found coagulopathy and respiratory failure were the two primary risk factors for clinically important bleeding (3.7% risk if any risk factor present). Use of enteral feeding was not protective. Some high-risk patients (burns, recent diagnosis of PUD etc.) received prophylaxis.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=8284001

      See also Rivers et al. under Sepsis.

Hepatology

Marrero J, Martinez FJ, Hyzy R. Advances in critical care hepatology. Am J Respir Crit Care Med 2003; 168:1421-6. Excellent concise review of the evaluation and management of fulminant hepatic failure, ascites, hepatorenal syndrome, hepatic encephalopathy, and hepatic dysfunction in sepsis. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=14668256

Garcia-Tsao, Sanyal A, Grace N, et al. Practice Guidelines Committee of the American Association for the Study of Liver Diseases and the Practice Parameters Committee of the American College of Gastroenterology.  Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis.  Am J Gastroenterol 2007;102:2086–2102.  Thorough update of the current practice guidelines for the treatment of varicies,; including use of antibiotics, octreotide, and IV PPI in the intensive care setting.  http://www.ncbi.nlm.nih.gov/pubmed/17879356?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

Sort P, Navasa M, Arroyo V, et al. Effect of intravenous albumin on renal impairment and mortality in patients with cirrhosis and spontaneous bacterial peritonitis. N Engl J Med 1999;341:403-9. RCT found addition of albumin to cefotaxime vs. antibiotic alone in above population preserved renal function and reduced mortality. Study does not provide information on volume resuscitation in the antibiotic-alone group, however, making it less clear whether albumin has additional benefit beyond what could be achieved with aggressive IVF.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=10432325

Pancreatitis

Banks PA, Freeman ML. Practice guidelines in acute pancreatitis. Am J Gastroenterol  2006; 101:2379-2400. The guidelines provide a comprehensive summary including diagnosis, nutritional support, and use of prophylactic antibiotics.  http://www.ncbi.nlm.nih.gov/pubmed/17032204?ordinalpos=3&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum