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Title: Stress-induced gastroduodenal lesions and total parenteral nutrition in critically ill patients: Frequency, complications, and the value of prophylactic treatment. A prospective, randomized study
Authors: Ruiz-Santana, S. 
Ortiz, E.
Gonzalez, B.
Bolanos, J.
Ruiz-Santana, A. J.
Manzano, J. L.
UNESCO Clasification: 32 Ciencias médicas
3201 Ciencias clínicas
Keywords: Gastroduodenal lesions
Parenteral nutrition
Issue Date: 1991
Journal: Critical Care Medicine 
Abstract: Objective: To assess the frequency, complications, and value of prophylactic treatment of stress-induced gastroduodenal lesions. Designs: Patients were prospectively randomized to treatment with total parenteral nutrition, either alone, with sucralfate, or with ranitidine. Setting: A multidisciplinary ICU from a tertiary care referral center. Patients: Ninety-seven patients submitted to prolonged mechanical ventilation, with normal hepatic and renal function, in metabolic stress, and receiving total parenteral nutrition. Interventions: On admission, we determined the Acute Physiology and Chronic Health Evaluation II score and the catabolic index score. We also performed an endoscopic examination on day 3, every 7 days subsequently, and whenever needed. Thirty patients received total parenteral nutrition alone. Twenty-four patients received total parenteral nutrition and sucralfate (1 g by nasogastric tube every 4 hrs). Nineteen patients received total parenteral nutrition and ranitidine (50 mg iv every 6 hrs). Main results: The overall occurrence rate of gastroduodenal mucosal damage was 29.6%. The overall frequency rate for stress ulcerations was 15.6% and was 6.2% for stress hemorrhage. There were no deaths secondary to stress hemorrhage. The difference in the frequency of stress-induced mucosal lesions and stress hemorrhage between the studied groups was not statistically significant. Conclusions: Additional prophylaxis to total parenteral nutrition in the form of sucralfate and ranitidine to prevent acute upper gastrointestinal bleeding is not required in this group of ICU patients.
ISSN: 0090-3493
DOI: 10.1097/00003246-199107000-00011
Source: Critical Care Medicine [ISSN 0090-3493], v. 19, p. 887-891
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