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Mendes JJ, Silva MJ, Miguel LS, Gonçalves MA, Oliveira MJ, Oliveira CDL, Gouveia J. Sociedade Portuguesa de Cuidados Intensivos guidelines for stress ulcer prophylaxis in the intensive care unit. Rev Bras Ter Intensiva 2019; 31:5-14. [PMID: 30843949 PMCID: PMC6443317 DOI: 10.5935/0103-507x.20190002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 09/08/2018] [Indexed: 12/18/2022] Open
Abstract
Critically ill patients are at risk of developing stress ulcers in the upper
digestive tract. Agents that suppress gastric acid are commonly prescribed to
reduce the incidence of clinically important stress ulcer-related
gastrointestinal bleeding. However, the indiscriminate use of stress ulcer
prophylaxis in all patients admitted to the intensive care unit is not warranted
and can have potential adverse clinical effects and cost implications. The
present guidelines from the Sociedade Portuguesa de Cuidados
Intensivos summarizes the current evidence and gives six clinical
statements and an algorithm aiming to provide a standardized prescribing policy
for the use of stress ulcer prophylaxis in the intensive care unit.
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Affiliation(s)
| | - Mário Jorge Silva
- Departamento de Gastrenterologia, Centro Hospitalar de Lisboa Central E.P.E. - Lisboa, Portugal
| | - Luís Silva Miguel
- Centro de Medicina Baseada em Evidência, Faculdade de Medicina, Universidade de Lisboa - Lisboa, Portugal
| | | | - Maria João Oliveira
- Departamento de Farmácia, Hospital Prof. Doutor Fernando da Fonseca E.P.E. - Amadora, Portugal
| | | | - João Gouveia
- Sociedade Portuguesa de Cuidados Intensivos - Lisboa, Portugal
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Nourian A, Mohammadi M, Beigmohammadi MT, Taher M, Dadvar Z, Malekolkottab M, Ramezani M, Khalili H. Comparing efficacy of enteral nutrition plus ranitidine and enteral nutrition alone as stress ulcer prophylaxis. J Comp Eff Res 2018; 7:493-501. [DOI: 10.2217/cer-2017-0098] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: Adequacy of enteral nutrition (EN) alone as stress ulcer prophylaxis (SUP) is controversial. The aim of this study was to compare efficacy of EN alone and ranitidine plus EN as SUP. Method: Critically ill adults with indications to receive SUP were randomized to ranitidine 50 mg IV every 8 h plus EN (SUP) or EN alone (non-SUP) group for 7 days. Besides, endoscopy was performed at the time of recruitment and on day 7. Results: During the study period, only one patient in each group of SUP and non-SUP experienced gastrointestinal bleeding. At the time of recruitment, gastric erosion and erythema were the most endoscopic findings in the SUP and non-SUP groups. These findings did not significantly change at the end of the study (p = 0.21). Conclusion: EN was at least effective as ranitidine plus EN as SUP.
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Affiliation(s)
- Anahid Nourian
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Mostafa Mohammadi
- Department of Intensive Care Unit, Imam Khomeini Hospital, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad-Taghi Beigmohammadi
- Department of Intensive Care Unit, Imam Khomeini Hospital, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Taher
- Department of Internal Medicine, Imam Khomeini Hospital, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Zohreh Dadvar
- Department of Internal Medicine, Imam Khomeini Hospital, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoume Malekolkottab
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoud Ramezani
- Department of Intensive Care Unit, Imam Khomeini Hospital, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Khalili
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
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