Life-threatening Bleeding - 2018

Life-threatening bleeding can be defined in many aspects: by extent of blood loss, by the presence of clinical and laboratory signs of tissue hypoperfusion or signs of organ functions failure. Sometimes bleeding is not associated with major blood loss, but it threatens the life by localization of bleeding to the regions important for maintaining vital functions (eg. brain). In our algorithm we pursue bleeding from esophageal varices, which are frequent complication of hepatic cirrhosis. The goal of this algorithm is to show you the right steps and resolution of the therapy of life-threatening bleeding.  

esophagus varice veins
Published at: 3.7.2018


Ivana Zýková, MD
Chief Physician of ICU, Department of Anesthesiology and Intensive Care, Regional hospital Liberec, Liberec

Bleeding from esophageal varices is life threatening and belongs to the most serious complications of portal hypertension. Interactive algorithm based on current guidelines leads investigators through prehospital and hospital management of treatment. Emphasis should be placed on ensuring vital functions, volume expansion and haemosubstitution, and correction of coagulopathy according to viscoelastic methods and, of course, to stop bleeding itself.


FEJFAR, T., et al. Léčba krvácení v důsledku portální hypertenze při jaterní cirhóze–aktualizace doporučených postupů ČHS ČLS JEP. Gastroent Hepatol, 2017, 71.2: 105-116.

KOZEK-LANGENECKER, Sibylle A., et al. Management of severe perioperative bleeding: guidelines from the European Society of Anaesthesiology: First update 2016. European Journal of Anaesthesiology (EJA), 2017, 34.6: 332-395.

ČEŠKA, Richard, et al. Interna. Stanislav Juhaňák-Triton, 2015. ISBN 978-80-7387-895-5.

ČERNÝ, Vladimír; MATĚJOVIČ, Martin; DOSTÁL, Pavel. Vybrané doporučené postupy v intenzivní medicíně. Maxdorf, 2009. ISBN 978-80-7345-183-7.

ŠEVČÍK, Pavel, et al. Intenzivní medicína. 3., přeprac. a rozš. vyd. Praha: Galén, 2014. 1195 s. ISBN 978-80-7492-066-0.

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