HDA: tratamiento (evidencias)

Upper Gastrointestinal Bleeding: Evidence-Base Treatment

By Salim Rezaie, MD | March 12th, 2014

"Upper gastrointestinal bleeding remains a common reason for emergency department visits and is a major cause of morbidity, mortality, and medical care costs. Often when these patients arrive, the classic IV-O2-Monitor is initiated and hemodynamic stability is assessed. Some of the next steps often performed include:

• Determination of the site and rate of bleeding (upper vs lower)
• Initiation of proton pump inhibitors (PPIs)
• Somatostatin analogs if variceal bleeding is suspected
• Prophylactic antibiotics
• Packed red blood cell (PRBC) transfusion for low hemoglobin and hematocrit levels

What is the evidence for these treatments, and do they affect morbidity and mortality?

SUMMARY OF TREATMENT MODALITIES EFFECT ON MORTALITY IN UGIB

Treatments that DO improve mortality in UGIB:

• Antibiotic prophylaxis in cirrhotic patients
• Restrictive transfusion strategy (transfuse if HgB < 7 g/dL)

Treatments that DO NOT improve mortality UGIB:

• Somatostatin analogues
• NG lavage
• PPIs (although may have some mortality benefit in Asian studies)"

http://academiclifeinem.com/upper-gastrointestinal-bleeding-treatment/

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