Stress-induced gastroduodenal lesions and total parenteral nutrition in critically ill patients: frequency, complications, and the value of prophylactic treatment. A prospective, randomized study.

摘要: Objective To assess the frequency, complications, and value of prophylactic treatment stress-induced gastroduodenal lesions. Design Patients were prospectively randomized to with total parenteral nutrition, either alone, sucralfate, or ranitidine. Setting A multidisciplinary ICU from a tertiary care referral center. Ninety-seven patients submitted prolonged mechanical ventilation, normal hepatic renal function, in metabolic stress, receiving nutrition. Interventions On admission, we determined Acute Physiology Chronic Health Evaluation II score catabolic index score. We also performed an endoscopic examination on day 3, every 7 days subsequently, whenever needed. Thirty received nutrition alone. Twenty-four sucralfate (1 g by nasogastric tube 4 hrs). Nineteen ranitidine (50 mg iv 6 Main Results The overall occurrence rate mucosal damage was 29.6%. frequency for stress ulcerations 15.6% 6.2% hemorrhage. There no deaths secondary difference lesions hemorrhage between studied groups not statistically significant. Conclusions Additional prophylaxis form prevent acute upper gastrointestinal bleeding is required this group patients. (Crit Care Med 1991; 19:887)