Abstract
Whether it is the primary reason for admission or a complication of critical illness, upper gastrointestinal bleeding is commonly encountered in the intensive care unit. In this setting, in the absence of endoscopy, intensivists generally provide supportive care (transfusion of blood products) and acid suppression (such as proton pump inhibitors). More recently, octreotide (a somatostatin analogue) has been used in such patients. However, its precise role in patients with upper gastrointestinal bleeding is not necessarily clear and the drug is associated with significant costs. In this issue of Critical Care, two expert teams debate the merits of using octreotide in non-variceal upper gastrointestinal bleeding.
Highlights
A 59 year old male has been admitted to the intensive care unit with febrile neutropenia and septic shock
There is evidence to support the use of octreotide in variceal and non-variceal upper GI bleeding (UGB)
The use of octreotide as a first, single therapy versus emergency sclerotherapy in bleeding esophageal varices was examined in a Cochrane systematic review of 12 randomized controlled trials (RCTs), including 6 trials of octreotide [6]
Summary
A 59 year old male has been admitted to the intensive care unit with febrile neutropenia and septic shock. GI = gastrointestinal; NVUGB = non-variceal upper gastrointestinal bleeding; PPI = proton pump inhibitor; RCT = randomized controlled trial; UGB = upper gastrointestinal bleeding. The panel of the Nonvariceal Upper GI Bleeding Consensus did not support the routine use of somatostatin or octreotide in non-variceal UGB.
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