Bleeding management in the ICU

Postoperative bleeding in the pediatric intensive care unit patient can result in significant morbidity or mortality. Differentiation between surgical and nonsurgical/coagulopathic bleeding is an important element of bleeding management. Recent definitions of bleeding severity are reviewed. Developmental hemostasis, patient age, and size are special considerations in pediatric bleeding management as are special surgical sites within small or contained areas vulnerable to even small extravascular blood volumes. Hemostatic control other than through blood product administration can be achieved through mechanical or other pharmaceutical adjuncts and a reference table is provided. Collaboration with interventional radiology should be explored in appropriate bleeding situations. An algorithm for resuscitation and management of the bleeding patient including communication prior to any reoperation is presented.