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Results for “Stress-ulcer prophylaxis”

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14 recordsLinked to original sources

PubMed2003

Clinically significant gastrointestinal bleeding in critically ill patients with and without stress-ulcer prophylaxis.

OBJECTIVE: To compare the rates of clinically significant gastrointestinal bleeding and the number of blood units and endoscopies required for gastrointestinal hemorrhage between patients receiving or not receiving stress-ulcer prophylaxis. DESIGN: Historical observational study comparing two consecutive periods: with (phase 1) and without stress-ulcer prophylaxis (phase 2). DESIGN AND SETTING: A 17-bed intensive care unit in a university teaching hospital. PATIENTS. In phase 1 there were 736 patients and in phase 2737. Those in the two phases were comparable in age and reason for admission; clinically significant gastrointestinal bleeding rates did not differ between the two phases, but patients in phase 2 were more severely ill. MEASUREMENTS AND RESULTS: Comparable numbers of blood units were transfused per bleeding patient in the two phases, especially for patients with significant gastrointestinal bleeding. During each phase 19 fibroscopies were performed for significant bleeding, and two patients required surgery. The clinically significant gastrointestinal bleeding rate and outcome did not differ in patients with at least one risk factor. Total expenditures directly related to gastrointestinal bleeding were similar during the two phases; the total cost incurred by stress-ulcer prophylaxis was estimated at 6700. CONCLUSIONS: Our results suggest that stress-ulcer prophylaxis does not influence the clinically significant gastrointestinal bleeding rate in intensive care unit patients or the cost of its management.

Aged↗

PubMed2026

Efficacy and safety of pantoprazole for stress-ulcer prophylaxis in critically ill patients: A systematic review and Meta-analysis of randomized controlled trials.

BACKGROUND: Stress-related mucosal damage (SRMD) is common in critically ill patients, and pharmacologic prophylaxis remains essential. This study evaluated the efficacy and safety of pantoprazole for stress-ulcer prophylaxis in ICU patients. MATERIALS AND METHODS: A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted per PRISMA-2020 guidelines. PubMed, Scopus, and CENTRAL were searched for studies comparing pantoprazole with placebo in adult and pediatric ICU patients. The primary outcome was clinically important gastrointestinal (GI) bleeding; secondary outcomes included mortality, ventilator-associated pneumonia (VAP), and Clostridioides difficile infection. RESULTS: Seven RCTs (n ≈ 9127; pantoprazole = 4575; placebo = 4552) were included. Pantoprazole significantly reduced clinically important GI bleeding (RR = 0.53; 95% CI 0.29-0.94; p = 0.03) without affecting overall mortality (RR ≈ 0.99 [95% CI 0.92-1.05]; p = 0.68). Infection rates were similar between groups (VAP: RR = 0.99; p = 0.78; C. difficile: RR = 1.11; p = 0.73). Sensitivity analyses confirmed robustness. CONCLUSIONS: Pantoprazole effectively reduces clinically important GI bleeding without increasing infection or overall mortality.

Pantoprazole↗

PubMed1984

Cimetidine for stress-ulcer prophylaxis.

Although cimetidine is more effective than a placebo for the prophylaxis of stress-induced ulcers, it has no advantage over titrated antacid dosing. Several comparative studies even suggest that combining cimetidine with antacid is no more effective than use of full-dose antacid. Therefore, we recommend prophylactic use of cimetidine only when very large dosages of antacid are required, in order to minimize acid-base disturbances.

Antacids↗

PubMed1991

[Perforation of a duodenal stress ulcer in a 7-year-old polytraumatized boy].

This is a report of a seven-year-old polytraumatised boy with perforation of a duodenal stress-ulcer. Aspects of the etiology and pathogenesis were discussed. The main therapeutical efforts by stress-ulcer risk patients consist in an early sufficient shock therapy and adequate stress-ulcer prophylaxis to prevent the origin of stress-ulcers and their complications like bleeding and perforation.

Child↗

PubMed1993

Bar-code technology applied to drug-use evaluation.

Bar-code technology was used to determine: (1) patterns in histamine H2-receptor antagonist use and (2) the occurrence of adverse drug effects and drug interactions associated with the use of these agents in critically ill patients. Patients at Henry Ford Hospital (Detroit) receiving histamine H2-receptor antagonists over a two-month period were evaluated. Clinical information was collected in the intensive care units by using a bar-code system. The data-capture menu was based on drug-use-evaluation criteria for H2-receptor antagonists. Data collected in the scanning wands were uploaded into a computer database and were analyzed at the end of the study. Data were collected for 207 patients. Cimetidine was the predominant H2-receptor antagonist used, and the predominant indication was stress-ulcer prophylaxis. Dosing trends followed accepted guidelines for cimetidine dosage adjustment in renal and hepatic failure. Two drug interactions and six adverse drug reactions occurred. Pharmacists made 92 recommendations to the medical staff regarding modification in therapy, involving 32% of the patients. Data collection required an average of 10 minutes per day each for three pharmacists. H2-receptor antagonist use patterns were evaluated in intensive care units through the application of bar-code technology. The speed and efficiency of this automated tool facilitated collection of a large amount of data.

Clinical Pharmacy Information Systems↗

PubMed1997

Nonantibiotic measures in the prevention of ventilator-associated pneumonia.

Aspiration of oropharyngeal and/or gastrointestinal (GI) contents is the main cause of ventilator-associated pneumonia. A number of nonantibiotic measures have been proposed to prevent aspiration eg, drainage of subglottic secretions or the semirecumbent position or to prevent gastric microbial overgrowth by stress-ulcer prophylaxis with sucralfate or early enteral feeding. Critical review of the studies shows that subglottic drainage does not prevent colonization or infection of the respiratory tract with intensive care unit-acquired Enterobacteriaceae or Pseudomonas aeruginosa. The effect of subglottic drainage on primary endogenous infections caused by Staphalococcus aureus and Streptococcus spp in patients not receiving antibiotics is only found in a post-hoc subgroup analysis and might reflect differences in carriage of community-acquired potentially pathogenic microorganisms (PPM) caused by previous antibiotic treatment, rather than a true treatment effect. The semirecumbent position may reduce the incidence of aspiration, particularly in patients without a nasogastric tube, but the aspiration rate remains high even in the short observation periods of the studies. There is no evidence that it reduces the ventilator-associated pneumonia rate. Sucralfate may reduce the increased pneumonia rate caused by H2-antagonists and/or antacids, but it remains to be proven whether it is superior to placebo. Sucralfate has no effect on the oropulmonary route of infection and has therefore no effect on early-onset (primary endogenous) pneumonia, which is characteristically caused by PPM carried in the oropharynx. Early enteral feeding is preferable to total parenteral feeding. However, there is limited evidence that it prevents ventilator-associated pneumonia. The studies showing a benefit of early enteral feeding were relatively small studies, partly in nonventilated patients, and used poorly defined criteria for pneumonia. The oropulmonary route is the most important route in the pathogenesis of pneumonia. Preventive strategies (both antibiotic and nonantibiotic strategies) have to block both the oropulmonary route and the gastropulmonary route to be fully effective. Because microaspiration cannot be fully prevented in critically ill patients, preventive strategies should attempt to eliminate PPM from the oropharynx and GI-tract.

Clinical Trials as Topic↗

PubMed1983

[Drug therapy and prevention of acute upper gastrointestinal hemorrhage].

As medical treatment of haemorrhage from esophageal varices vasopressin is discussed. The analogue triglycyl-vasopressin has less side-effects and a longer plasma half-life. According to the first randomized study with only a small number of patients bleeding from varices triglycyl-vasopressin was superior to vasopressin. The efficacy of somatostatin to reduce splanchnic blood flow in patients with liver cirrhosis is controversial. In a placebo-controlled trial propranolol prevented rebleeding from varices in patients with cirrhosis. However, beta-blockers should not be given to patients with advanced cirrhosis. Several controlled studies prove cimetidine not to be effective in ulcer bleeding. Somatostatin and secretin could be candidates for pharmacotherapy of haemorrhage from ulcers and erosions. In an own randomized and multicenter trial on 100 patients with stopped ulcer bleeding it was proven that the combination of the synergistically acting receptor antagonists cimetidine and pirenzepine prevent rebleeding significantly better than a prophylactic treatment of either cimetidine or pirenzepine alone. An improvement of mortality rates of upper gastrointestinal bleeding seems also to be possible by using such a combined prophylaxis. As prophylaxis of stress-ulcer bleeding cimetidine - recently ranitidine, too - and antacids are applied. Instead of a widely used enhancement of the doses of H2-blockers a combined application of H2-receptor antagonists and pirenzepine is also recommended in this indication which offers theoretical and practical advantages.

Acute Disease↗

PubMed1994

Infection control in critically ill patients: effects of selective decontamination of the digestive tract.

The use of selective decontamination of the digestive tract (SDD) to control infection in the intensive care unit (ICU) is reviewed. There are three basic patterns of infection in the ICU: primary endogenous, secondary endogenous, and exogenous. In exogenous infection, no microbial carriage precedes colonization and infection. In endogenous infection, infection is preceded by oropharyngeal or GI carriage. A primary endogenous infection is caused by an organism carried by the patient on admission to the ICU, whereas a secondary endogenous infection is caused by organisms acquired in the ICU. The traditional approach to infection control in the ICU has included frequent hand washing, limiting the use of agents for prophylaxis of stress-ulcer bleeding, and limiting the use of injectable antimicrobials to the treatment of infection in order to prevent resistance. The recognition that hand washing only partially reduces endogenous infection led to the use of nonabsorbable antimicrobials to abolish oropharyngeal and gastrointestinal carriage of potentially pathogenic microorganisms. In addition, the use of an injectable antimicrobial during the first four days in the ICU to control primary endogenous infection was considered not to lead to resistance as long as it was combined with nonabsorbable antimicrobials. Of 41 fully reported clinical trials of SDD, 33 showed a significant reduction of infectious morbidity among patients who received SDD. Of the 32 trials in which carriage of potential pathogens was a measured endpoint, 31 showed a reduction in carriage. Of the 24 studies in which resistance was an endpoint, 22 showed no increase in resistance associated with SDD. Only 10 of 35 trials that examined death showed a significant decrease in mortality. SDD, used in conjunction with traditional infection-control measures, diminishes microbial carriage and infectious morbidity in the ICU without increasing antimicrobial resistance.

Critical Care↗

PubMed1986

[Prevention of stress ulcers with cimetidine and ranitidine. Comparative studies within the scope of cardiosurgical interventions].

2 H2-receptor antagonists--Cimetidine and Ranitidine--were applied in our prospective randomized study in 100 cardio-surgical cases in order to test their therapeutical efficiency for the prophylaxis of bleedings of gastroduodenal stress-ulcers. During the phase of the intensive therapy of 2 days the patients of group A received t.i.d. 400 mg of Cimetidine i.v. and those of group B twice a day 150 mg of Ranitidine i.v. The following tests were realized: gastric acidity, plasma level, side-effects, hemorrhages and ulcers. The gastric 8 o'clock pH-level of group A (Cimetidine) during this intensive therapy was significantly (p = 0.0001) higher than the respective level of group B (Ranitidine). Other parameters were not showing any statistical differences between both groups. Acute gastro-intestinal hemorrhages because of stress-ulcers were not noticed during the test.

Cimetidine↗

PubMed1980

[Stress-ulcer prevention with pirenzepine-a controlled study].

In polytraumatised or septic patients without adequate medical prophylaxis the incidence-rate of postoperative complications is very high. The incidence-rate of acute mucosal stress lesions is to be expected 100 per cent. The parenteral application of pirenzepine shows in comparison to placebo a clear protective effect measured as incidence-rate of stress lesion (p greater than 0,05) and occurrence of bleeding (p greater than 0,01).

Benzodiazepinones↗

PubMed1994

The virtual absence of stress-ulceration related bleeding in ICU patients receiving prolonged mechanical ventilation without any prophylaxis. A prospective cohort study.

OBJECTIVE: To study the incidence of stress-ulcer related bleeding in ICU patients receiving prolonged (> 2 days) mechanical ventilation without any stress ulceration prophylaxis. DESIGN: A prospective cohort study in 183 patients. INTERVENTIONS: All patients received clinical treatment including maintenance of adequate tissue perfusion (with low dose inotropes and vasodilators), infection prevention (by selective decontamination of the digestive tract) throughout ICU stay and suppression of generalized inflammatory reaction (by steroids). SETTING: Medical/surgical ICU of a major teaching hospital in Amsterdam (Onze Lieve Vrouwe Gasthuis). MEASUREMENTS AND RESULTS: 167 patients were evaluated during 2182 treatment days in the ICU and during 1753 days on mechanical ventilation without stress ulceration prophylaxis. The mean total risk score for stress ulceration related bleeding was 38 (Tryba score). Stress ulceration related bleeding developed in 1 patient (0.6%). CONCLUSIONS: The incidence of SURB was less then 1% in this cohort of ICU patients receiving longterm mechanical ventilation with a high risk for SURB (mean total risk score 38). All patients received agressive shock resuscitation, infection prevention with selective decontamination of the digestive tract (SDD) and suppression of inflammatory response with steroids. Further studies are needed to evaluate the contribution of each of these elements of the integral approach.

Aged↗

PubMed1978

[Histamine H2-receptor blockade and thrombosis prophylaxis with heparin in tetanus. A case report (author's transl)].

The use of "low-dose" heparin for the purpose of the prophylaxis of thrombosis is not yet general in the treatment of tetanus because this therapy may increase the risk of bleeding gastrointestinal stress-ulcers. The combination of heparin with histamine H2-receptor blockers, however, may be of therapeutic benefit and may reduce this complication as well as thrombosis. A case of tetanus and its therapy is reported.

Ampicillin↗

PubMed1976

[Acute hemorrhage of the upper digestive tract with special reference to stress ulcer. Prevention and surgical therapy].

For the surgical therapy of an acute stress-ulcer bleeding there are three methods to someones disposal: 1.) the local care of a bleeding source 2.) the partial gastrectomy and 3.) vagotomy with pyloroplasty and local care of a bleeding source and as prophylaxis of an acute stomach bleeding the highly selective vagotomy with or without pyloroplasty. On judging the success of these methods, some has to consider the basal illness with its letality, because it is to differ, wether a patient died postoperative on his basal disease, or on the effect of the operation, or out of deficient control of the situation. Considering such points it comes out clear, that today the vagotomy with a drainage operation is the method of choice, because: 1.) through this intervention patients are tainted less as for instance through a partial gastrectomy, 2.) through a technical faultless done operation, especially through a vagotomy a success concerning a relapse bleeding is guaranteed. Beside that, the highly selective vagotomy without drainage operation presents itself as prophylactic measure, to prevent an acute stomach bleeding in a number of transplanted patients (kidney transplantation). The first experiences with this method show, that a improvement of the results is to be expected.

Acute Disease↗

PubMed1987

Nosocomial pneumonia in intubated patients given sucralfate as compared with antacids or histamine type 2 blockers. The role of gastric colonization.

Gram-negative nosocomial pneumonia may result from retrograde colonization of the pharynx from the stomach, and this may be more likely when the gastric pH is relatively high. We studied the rate of nosocomial pneumonia among 130 patients given mechanical ventilation in an intensive care unit who were receiving as prophylaxis for stress ulcer either sucralfate (n = 61), which does not raise gastric pH, or conventional treatment with antacids, histamine type 2 (H2) blockers, or both (n = 69). At the time of randomization to treatment, the two groups were similar in age, underlying diseases, and severity of acute illness. Patients in the sucralfate group had a higher proportion of gastric aspirates with a pH less than or equal to 4 (P less than 0.001) and significantly lower concentrations of gram-negative bacilli (P less than 0.05) in gastric aspirates, pharyngeal swabs, and tracheal aspirates than did patients in the antacid-H2-blocker group. The rate of pneumonia was twice as high in the antacid-H2 group as in the sucralfate group (95 percent confidence interval, 0.89 to 4.58; P = 0.11). Gram-negative bacilli were isolated more frequently from the tracheal aspirates of patients with pneumonia who were receiving antacids or H2 blockers. Mortality rates were 1.6 times higher in the antacid-H2 group than in the sucralfate group (95 percent confidence interval, 0.99 to 2.50; P = 0.07). Although our results fell just short of statistical significance when they were analyzed according to intention to treat, they suggest that agents that elevate gastric pH increase the risk of nosocomial pneumonia in patients receiving ventilation by favoring gastric colonization with gram-negative bacilli. We conclude that in patients receiving mechanical ventilation, the use of a prophylactic agent against stress-ulcer bleeding that preserves the natural gastric acid barrier against bacterial overgrowth may be preferable to antacids and H2 blockers.

Antacids↗