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Practical Strategies Related to the Application of Balloon Tamponade Therapy in Acute Variceal Bleeding
IMPORTANCE: Acute gastrointestinal variceal hemorrhage is a major cause of morbidity and mortality in cirrhotic liver disease. Approximately one-third of cirrhotic patients will have variceal hemorrhage, and each bleeding episode is associated with up to 20% mortality. Balloon tamponade devices are...
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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Lippincott Williams & Wilkins
2022
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9380694/ https://www.ncbi.nlm.nih.gov/pubmed/35982839 http://dx.doi.org/10.1097/CCE.0000000000000748 |
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author | Bari, Vase Subramanian, Ram Mohan |
author_facet | Bari, Vase Subramanian, Ram Mohan |
author_sort | Bari, Vase |
collection | PubMed |
description | IMPORTANCE: Acute gastrointestinal variceal hemorrhage is a major cause of morbidity and mortality in cirrhotic liver disease. Approximately one-third of cirrhotic patients will have variceal hemorrhage, and each bleeding episode is associated with up to 20% mortality. Balloon tamponade devices are used to achieve temporary hemostasis of bleeding esophagogastric varices and as a bridge to definitive therapy. Rapid and proper placement is crucial in a life-threatening bleed both to improve patient’s chances of survival and minimize procedural complications. Passage of the tube can be complicated by coiling in the oropharynx or mid-esophagus particularly if an endotracheal tube is in place or the patient has large variceal burden. Endoscopic placement can be a useful adjunct but may not be readily accessible depending on resources and availability of specialists. Here, we describe a technique of balloon tamponade placement using a stiffening guidewire to overcome this challenge. OBJECTIVES: The objectives were to: 1) describe the guidewire method for balloon tamponade tube placement and 2) highlight proof of concept through clinical application. DESIGN: We conducted a retrospective case series of patients treated with balloon tamponade using the guidewire method. SETTING AND PARTICIPANTS: This study was done at a single-center quaternary-care facility. Patients admitted to the surgical ICU and treated with a balloon tamponade device for acute variceal hemorrhage were included. MAIN OUTCOMES AND MEASURES: Patient characteristics were assessed including age, sex, model for end stage liver disease score, etiology of cirrhosis, and definitive treatment received. RESULTS: Nine patients were included in the final analysis. Mean age was 50 ± 19, and mean model for end stage liver disease was 39 ± 8. Alcohol cirrhosis was the most common cause of cirrhosis in this sample (n = 5). Six patients were able to be bridged to definitive treatment. CONCLUSIONS AND RELEVANCE: Guidewire-assisted balloon tamponade placement is practical, is effective, and can be performed by acute care providers. |
format | Online Article Text |
id | pubmed-9380694 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Lippincott Williams & Wilkins |
record_format | MEDLINE/PubMed |
spelling | pubmed-93806942022-08-17 Practical Strategies Related to the Application of Balloon Tamponade Therapy in Acute Variceal Bleeding Bari, Vase Subramanian, Ram Mohan Crit Care Explor Observational Study IMPORTANCE: Acute gastrointestinal variceal hemorrhage is a major cause of morbidity and mortality in cirrhotic liver disease. Approximately one-third of cirrhotic patients will have variceal hemorrhage, and each bleeding episode is associated with up to 20% mortality. Balloon tamponade devices are used to achieve temporary hemostasis of bleeding esophagogastric varices and as a bridge to definitive therapy. Rapid and proper placement is crucial in a life-threatening bleed both to improve patient’s chances of survival and minimize procedural complications. Passage of the tube can be complicated by coiling in the oropharynx or mid-esophagus particularly if an endotracheal tube is in place or the patient has large variceal burden. Endoscopic placement can be a useful adjunct but may not be readily accessible depending on resources and availability of specialists. Here, we describe a technique of balloon tamponade placement using a stiffening guidewire to overcome this challenge. OBJECTIVES: The objectives were to: 1) describe the guidewire method for balloon tamponade tube placement and 2) highlight proof of concept through clinical application. DESIGN: We conducted a retrospective case series of patients treated with balloon tamponade using the guidewire method. SETTING AND PARTICIPANTS: This study was done at a single-center quaternary-care facility. Patients admitted to the surgical ICU and treated with a balloon tamponade device for acute variceal hemorrhage were included. MAIN OUTCOMES AND MEASURES: Patient characteristics were assessed including age, sex, model for end stage liver disease score, etiology of cirrhosis, and definitive treatment received. RESULTS: Nine patients were included in the final analysis. Mean age was 50 ± 19, and mean model for end stage liver disease was 39 ± 8. Alcohol cirrhosis was the most common cause of cirrhosis in this sample (n = 5). Six patients were able to be bridged to definitive treatment. CONCLUSIONS AND RELEVANCE: Guidewire-assisted balloon tamponade placement is practical, is effective, and can be performed by acute care providers. Lippincott Williams & Wilkins 2022-08-15 /pmc/articles/PMC9380694/ /pubmed/35982839 http://dx.doi.org/10.1097/CCE.0000000000000748 Text en Copyright © 2022 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND) (https://creativecommons.org/licenses/by-nc-nd/4.0/) , where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. |
spellingShingle | Observational Study Bari, Vase Subramanian, Ram Mohan Practical Strategies Related to the Application of Balloon Tamponade Therapy in Acute Variceal Bleeding |
title | Practical Strategies Related to the Application of Balloon Tamponade Therapy in Acute Variceal Bleeding |
title_full | Practical Strategies Related to the Application of Balloon Tamponade Therapy in Acute Variceal Bleeding |
title_fullStr | Practical Strategies Related to the Application of Balloon Tamponade Therapy in Acute Variceal Bleeding |
title_full_unstemmed | Practical Strategies Related to the Application of Balloon Tamponade Therapy in Acute Variceal Bleeding |
title_short | Practical Strategies Related to the Application of Balloon Tamponade Therapy in Acute Variceal Bleeding |
title_sort | practical strategies related to the application of balloon tamponade therapy in acute variceal bleeding |
topic | Observational Study |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9380694/ https://www.ncbi.nlm.nih.gov/pubmed/35982839 http://dx.doi.org/10.1097/CCE.0000000000000748 |
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