LAUSR

www.ccmjournal.org Critical Care Medicine • Volume 46 • Number 1 (Supplement) Learning Objectives: Terlipressin (triglycyl lysine vasopressin) is a synthetic analogue of vasopressin, which has been used in the treatment of acute variceal hemorrhage. In contrast to vasopressin, terlipressin can be administered as intermittent injections instead of continuous intravenous infusion and it seems to have a safer adverse reactions profile. The objective is to determine if bolus injections of terlipressin are safe and improve outcome rate from ICU in acute esophageal variceal hemorrhage. Methods: Terlipressin was used in a bolus intravenous injection of 2mg in 18 patients (all males, 52.16 ± 6.14years old), known as cirrhotic patients Child Pugh B/C, after an acute esophageal variceal bleeding, being transported to hospital. They were received directly in ICU, where resuscitation was provided, with promotion of blood volume restitution to maintain hemoglobin at around 8 g/dL and plasma expanders to maintain systolic blood pressure bigger than 80mmHg. Norfloxacin 400 mg twice was initiated immediately. Endoscopic band ligation was performed before 12h. Bolus intravenous injections of 2mg of terlipressin were maintained each 4 h for the first 48 h, and then continued at a lower dose of 1 mg each 4 h, planned for up to five days. Results: Seventeen patients had cessation of bleeding after endoscopic procedure. Only one presented a new massive bleeding, uncontrolled despite the use of Sengstaken tube, dying after cardiorespiratory arrest. Fourteen patients were discharged from ICU in four days,two had a prolonged stay due to hepato-renal syndrome and one died later due to cardiorespiratory complications. The use of red blood cells concentrates did not surpass 3.16 ± 0.98 units, excluding the case of new massive bleeding. Conclusions: The use of bolus intravenous injections of terlipressin in cirrhotic Child Pugh B/C patients having an acute esophageal variceal bleeding seems safe and efficient to reduce blood transfusions and ICU stay.