Chapter 25. Gastrointestinal Bleeding in the ICU

Nikhil R Asher, MD;; Kevin McGrath, MD;; Douglas B White, MD, MAS
DOI: 10.1378/critcare.21.25
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  • Identify high risk patients presenting with acute GI bleeding (GIB); recognize patients in the ICU at highest risk of developing GIB.

  • Develop an effective strategy for initial evaluation and management of patients with acute, severe GI hemorrhage.

  • Recognize risk factors for recurrent upper GI hemorrhage and discuss management strategies to reduce risk of recurrent bleeding.

  • Discuss therapeutic options for management of patients with lower GIB.

  • Discuss appropriate stress ulcer prophylaxis in critically ill patients.


GI bleeding (GIB) associated with high-risk features should be managed within an ICU setting. Patients presenting with GIB must have timely identification of high-risk features and appropriate management. Furthermore, patients already admitted to an ICU for an unrelated diagnosis are at risk for GIB. Critically ill patients at risk for GIB must receive appropriate prophylactic therapies. This review covers the key aspects of evaluation and management of patients with acute, severe GI hemorrhage and discusses risk-reduction strategies for GIB arising in ICU patients.


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