Aymeric Becq1, Saik Urien2, Maximilien Barret3, Christophe Faisy2. 1. Department of Gastroenterology and Endoscopy, Saint Antoine Hospital, Assistance Publique - Hôpitaux de Paris, 184 rue du Faubourg Saint Antoine, 75012, Paris, France. Aymeric.becq@aphp.fr. 2. Clinical Investigations Center-1419 INSERM, EA7323 - University Paris-Descartes Sorbonne-Paris Cité, Paris, France. 3. Department of Gastroenterology, Cochin Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France.
Abstract
BACKGROUND: Epinephrine may impair splanchnic blood flow, but the impact of epinephrine dose on the occurrence of clinically significant gastrointestinal bleeding (CSGB) caused by stress ulcer remains unclear. We investigated the effect of epinephrine dose on the occurrence of stress ulcer-related CSGB in intensive care unit (ICU) patients. METHODS: In this prospective, observational, cohort study conducted in a French teaching hospital, 40 consecutive ICU patients receiving epinephrine infusion in whom a stress ulcer was diagnosed by an upper gastrointestinal endoscopy were included, from February 2010 to July 2015. The effects of epinephrine dose, and other covariates, on the occurrence of stress ulcer-related CSGB were analyzed using a multiple logistic regression model for repeated measures: At each observation, each patient serves as his own control. RESULTS: A total of 1484 time-dependent epinephrine dose modifications were available for analysis. The median epinephrine dose rate was 0.8 (0-9.5) mg/h, and the median epinephrine cumulative dose was 44.8 (2.6-2343) mg. Epinephrine, expressed as the average dose per day at time t, had a significant protective effect on the occurrence of stress ulcer (odds ratio 0.22; 95% confidence interval (CI), 0.12-0.38; p < 0.0001, for a log10 increase of epinephrine dose). Enteral feeding had also a protective effect (odds ratio 0.55; 95% CI 0.41-0.72; p < 0.0001, for a log10 increase of kcal/day). Only renal replacement therapy increased the occurrence of stress ulcer in the model. CONCLUSIONS: An increase in the average dose of epinephrine per day increased the time to occurrence of stress ulcer in critically ill patients.
BACKGROUND:Epinephrine may impair splanchnic blood flow, but the impact of epinephrine dose on the occurrence of clinically significant gastrointestinal bleeding (CSGB) caused by stress ulcer remains unclear. We investigated the effect of epinephrine dose on the occurrence of stress ulcer-related CSGB in intensive care unit (ICU) patients. METHODS: In this prospective, observational, cohort study conducted in a French teaching hospital, 40 consecutive ICU patients receiving epinephrine infusion in whom a stress ulcer was diagnosed by an upper gastrointestinal endoscopy were included, from February 2010 to July 2015. The effects of epinephrine dose, and other covariates, on the occurrence of stress ulcer-related CSGB were analyzed using a multiple logistic regression model for repeated measures: At each observation, each patient serves as his own control. RESULTS: A total of 1484 time-dependent epinephrine dose modifications were available for analysis. The median epinephrine dose rate was 0.8 (0-9.5) mg/h, and the median epinephrine cumulative dose was 44.8 (2.6-2343) mg. Epinephrine, expressed as the average dose per day at time t, had a significant protective effect on the occurrence of stress ulcer (odds ratio 0.22; 95% confidence interval (CI), 0.12-0.38; p < 0.0001, for a log10 increase of epinephrine dose). Enteral feeding had also a protective effect (odds ratio 0.55; 95% CI 0.41-0.72; p < 0.0001, for a log10 increase of kcal/day). Only renal replacement therapy increased the occurrence of stress ulcer in the model. CONCLUSIONS: An increase in the average dose of epinephrine per day increased the time to occurrence of stress ulcer in critically illpatients.
Authors: T Michida; S Kawano; E Masuda; I Kobayashi; Y Nishimura; M Tsujii; Y Takei; S Tsuji; K Nagano; H Fusamoto; T Kamada; T Sugimoto Journal: Am J Gastroenterol Date: 1997-07 Impact factor: 10.864
Authors: D J Cook; H D Fuller; G H Guyatt; J C Marshall; D Leasa; R Hall; T L Winton; F Rutledge; T J Todd; P Roy Journal: N Engl J Med Date: 1994-02-10 Impact factor: 91.245
Authors: Mette Krag; Anders Perner; Jørn Wetterslev; Matt P Wise; Mark Borthwick; Stepani Bendel; Colin McArthur; Deborah Cook; Niklas Nielsen; Paolo Pelosi; Frederik Keus; Anne Berit Guttormsen; Alma D Moller; Morten Hylander Møller Journal: Intensive Care Med Date: 2015-04-10 Impact factor: 17.440