Karim El-Kersh1, Bilal Jalil2, Stephen A McClave3, Rodrigo Cavallazzi2, Juan Guardiola2, Karen Guilkey2, Annuradha K Persaud4, Stephen P Furmanek4, Brian E Guinn4, Timothy L Wiemken4, Bashar Chihada Alhariri2, Scott P Kellie2, Mohamed Saad2. 1. University of Louisville School of Medicine, Department of Internal Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Louisville, KY, United States. Electronic address: karim.elkersh@louisville.edu. 2. University of Louisville School of Medicine, Department of Internal Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Louisville, KY, United States. 3. University of Louisville School of Medicine, Department of Internal Medicine, Division of Gastroenterology, Hepatology and Nutrition, University of Louisville, KY, United States. 4. University of Louisville School of Medicine, Department of Internal Medicine, Division of Infectious Disease, University of Louisville, KY, United States.
Abstract
PURPOSE: We investigated whether early enteral nutrition alone may be sufficient prophylaxis against stress-related gastrointestinal (GI) bleeding in mechanically ventilated patients. MATERIALS AND METHODS: Prospective, double blind, randomized, placebo-controlled, exploratory study that included mechanically ventilated patients in medical ICUs of two academic hospitals. Intravenous pantoprazole and early enteral nutrition were compared to placebo and early enteral nutrition as stress-ulcer prophylaxis. The incidences of clinically significant and overt GI bleeding were compared in the two groups. RESULTS:124 patients were enrolled in the study. After exclusion of 22 patients, 102 patients were included in analysis: 55 patients in the treatment group and 47 patients in the placebo group. Two patients (one from each group) showed signs of overt GI bleeding (overall incidence 1.96%), and both patients experienced a drop of >3 points in hematocrit in a 24-hour period indicating a clinically significant GI bleed. There was no statistical significant difference in the incidence of overt or significant GI bleeding between groups (p=0.99). CONCLUSION: We found no benefit when pantoprazole is added to early enteral nutrition in mechanically ventilated critically ill patients. The routine prescription of acid-suppressive therapy in critically ill patients who tolerate early enteral nutrition warrants further evaluation.
RCT Entities:
PURPOSE: We investigated whether early enteral nutrition alone may be sufficient prophylaxis against stress-related gastrointestinal (GI) bleeding in mechanically ventilated patients. MATERIALS AND METHODS: Prospective, double blind, randomized, placebo-controlled, exploratory study that included mechanically ventilated patients in medical ICUs of two academic hospitals. Intravenous pantoprazole and early enteral nutrition were compared to placebo and early enteral nutrition as stress-ulcer prophylaxis. The incidences of clinically significant and overt GI bleeding were compared in the two groups. RESULTS: 124 patients were enrolled in the study. After exclusion of 22 patients, 102 patients were included in analysis: 55 patients in the treatment group and 47 patients in the placebo group. Two patients (one from each group) showed signs of overt GI bleeding (overall incidence 1.96%), and both patients experienced a drop of >3 points in hematocrit in a 24-hour period indicating a clinically significant GI bleed. There was no statistical significant difference in the incidence of overt or significant GI bleeding between groups (p=0.99). CONCLUSION: We found no benefit when pantoprazole is added to early enteral nutrition in mechanically ventilated critically illpatients. The routine prescription of acid-suppressive therapy in critically illpatients who tolerate early enteral nutrition warrants further evaluation.
Authors: Marija Barbateskovic; Søren Marker; Anders Granholm; Carl Thomas Anthon; Mette Krag; Janus Christian Jakobsen; Anders Perner; Jørn Wetterslev; Morten Hylander Møller Journal: Intensive Care Med Date: 2019-01-24 Impact factor: 17.440