The mortality associated with bleeding stress ulcers in patients in intensive care units exceeds 50%. Iden tification of patients at risk and use of early and effec tive prophylaxis are necessary in the management of patients in intensive care units. The use of antacids is inconvenient, expensive, and associated with electro lyte disturbances and erratic pH control. H2-receptor antagonists are the preferred agents for stress ulcer pro phylaxis because of their proven efficacy, safety, and ease of administration. Adjunct therapy with cyto protective agents may be useful in patients with com promised mucosal defences.
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References
1.
Shuman RB, Schuster DP, Zuckerman GRProphylactic therapy for stress ulcer bleeding: a reappraisal. Ann Intern Med1987;106:562-567
2.
Gonzalez ER, Morkunas ARProphylaxis of stress ulcers: antacid titration vs. histamine-2 receptor blockade . Drug Intell Clin Pharm1985;19:807-811
3.
Peura DA, Johnson LFCimetidine for prevention and treatment of gastroduodenal mucosal lesions in patients in an intensive care unit. Ann Intern Med1985;103:173-177
4.
Gottlieb JE, Menashe PI, Cruz E.Gastrointestinal complications in critically ill patients: the intensivists' overview. Am J Gastroenterol1986;81:227-238
5.
Schuster DP, Rowley H., Feinstein S., et al. Prospective evaluation of the risk of upper gastrointestinal bleeding after admission to a medical intensive care unit. Am J Med1984;76: 623-630
Thompson JC, Walker JPIndications for the use of parenteral H2-receptor antagonists. Am J Med1984;77(suppl 5B):111-115
8.
Kauffman GLMucosal damage to the stomach: how, when, and why?Scand J Gastroenterol1984;19(suppl 105):19-26
9.
Hawkey CJ, Rampton DSProstaglandins and the gastrointestinal mucosa: are they important in its function, disease or treatment?Gastroenterology1985;89:1162-1188
10.
Banks S.Stress ulcer—prevention of gastrointestinal bleeding in critical care units. Med J Aust1985;142:S17-S21
11.
skillman JJ, Bushnell LS, Goldman H., et al. Respiratory failure, hypotension, sepsis, and jaundice: a clinical syndrome associated with lethal hemorrhage from acute stress ulceration of the stomach. Am J Surg1969;117:523-555
12.
Hastings PR , Skillman JJ, Bushnell LS, et al. Antacid titration in the prevention of acute gastrointestinal hemorrhage. N Engl J Med1978;298:1041-1045
13.
Priebe HJ, Skillman JJ, Bushnell LS, et al. Antacids versus cimetidine in preventing acute gastrointestinal bleeding. N Engl J Med1980;302:426-430
14.
Zinner MJ, Zuidema GD, Smith PL, et al. The prevention of upper gastrointestinal tract bleeding in patients in an intensive care unit. Surg Gynecol Obstet1981;153:214-220
15.
Stothert JC , Dellinger EP, Simonwitz DA, et al. Gastric pH monitoring as a prognostic indicator for the prophylaxis of stress ulceration in the critically ill. Am J Surg1980;140:761-763
16.
McElwee HP, Sirinek KR, Levine BACimetidine affords protection equal to antacids in prevention of stress ulceration following thermal injury. Surgery1979;86:620-626
17.
Khan F., Parekh A., Patel S.Result of gastric neutralization with hourly antacids and cimetidine in 320 intubated patients with respiratory failure. Chest1981;79:409-412
18.
Larson GM, Kock S., O'Dorisio TM, et al. Gastric response to severe head injury. Am J Surg1984;147:97-105
19.
Poleski MH, Spanier AHCimetidine vs antacids in the prevention of stress erosions in critically ill patients. Am J Gastroenterol1986;81:107-111
20.
Bond VK, Stoelting RK, Gupta CDPulmonary aspiration syndrome after inhalation of gastric fluid containing antacids. Anesthesiology1979;51:452-453
21.
Hallbran LG , Gayle WE, Zfass AM, et al. Prevention of acute gastrointestinal complications after severe head injury: a controlled clinical trial of cimetidine prophylaxis. Am J Surg1980;139:44-48
22.
Silvestri N. , Curzio M., Molta U., et al. Cimeditine to prevent stress ulcers . Lancet1980;1:885-886
23.
Basso N., Bagarani M., Materia A., et al. Cimetidine and antacid prophylaxis of acute upper gastrointestinal bleeding in high risk patients: a controlled randomized trial. Am J Surg1981; 141:339-341
24.
Hermann V., Kaminski DLElevation of intragastric pH in acutely ill patients. Arch. Surg1979;114:511-514
25.
Friedman CJ , Ohlinger MJ, Surratt PM, et al. Prophylaxis of upper gastrointestinal hemorrhage in patients requiring mechanical ventilation . Crit Care Med1982;10:316-319
26.
Liu YL, Yuan KJPrevention of stress ulcer bleeding with cimetidine in severe burns. Burns Incl Therm Inj1983;9: 327-329
27.
Weigelt JA, Aurbakker CM, Gewertz BL, et al. Cimetidine versus antacids in prophylaxis for stress ulceration . Arch Surg1981;116:597-601
28.
Martin LF, Max MH, Polk WCFailure of gastric pH control by antacids or cimetidine in the critically ill: a valid sign of sepsis. Surgery1980;88:59-68
29.
Martin LF, Stalock DK, Simonwitz DA, et al. Failure of cimetidine prophylaxis in the critically ill. Arch Surg1979; 114:492-495
30.
Schiessel R. , Starlinger M., Wolf A., et al. Failure of cimetidine to prevent gastroduodenal ulceration and bleeding after renal transplantation . Surgery1981;90:456-459
31.
Bevines BA, Rogers EL, Rapp RP, et al. Clinical failures with cimetidine. Surgery1980;88:417-420
32.
Macdougall Brd, Bailey RJ, Williams R H2 receptor antagonists versus antacids in the prevention of acute gastrointestinal hemorrhage in fulminant hepatic failure: two controlled clinical trials. Lancet1976;1:617-619
33.
Jones RH, Rudge CJ, Bewick M., et al. Cimetidine prophylaxis against upper gastrointestinal hemorrhage after transplantation. Br Med J1978;1:398-400
34.
Bubric MP, Wetherille RE, Onstad GR, et al. Control of acute gastroduodenal hemorrhage with cimetidine. Surgery1978; 84:510-518
35.
Priebe HJ, Skillman JJMethods of prophylaxis in stress ulcer disease. World J Surg1981;5:223-233
36.
Ostro MJ, Russell JA, Solding SJ, Mahon WA, Jeejeebhoy KNControl of gastric pH with cimetidine: boluses versus primed infusions . Gastroenterology1985;89:532-537
37.
Siepler JKA dosage alternative for H2 receptor-antagonists—constant infusion . Clin Ther1986;8(suppl A):24-33
38.
Mu-Chow KJ, Baptista RJCost-effectiveness of parenteral nutrient solutions containing cimetidine hydrochloride. Am J Hosp Pharm1984;41:1324-1325
39.
Gonzalez ER , Dasta J., Angaran D., et al. Cost and formulary factors in stress ulcer prophylaxis. J Crit Ill1988;3(suppl 9):S76-S79
40.
Barth HO, Brunner G., Berg F., et al. Ranitidine versus cimetidine in preventing acute gastroduodenal bleeding: a randomized trial in 193 critically ill patients: a multicenter study in Germany. Intensivmedizin1984;21:15-18
41.
Siepler J., Prindiville T., Nishikawa R., Trudeau W.Prophylaxis of stress ulceration in the ICU: a comparison of cimetidine and ranitidine constant infusion (abstract). Gastroenterology1987;90:1639
42.
Kiowski W., Frei A.Bolus injection of cimetidine and hypotension in patients in the intensive care unit: incidence and mechanism. Arch Intern Med1987;147:153-156
43.
Sorkin EM, Darvey DLReview of cimetidine drug interactions. Drug Intell Clin Pharm1983;17:110-120
44.
Somogyi A., Muirhead M.Pharmacokinetic interactions of cimetidine 1987. Clin Pharmacokinet1987;12:321-366
45.
Kirch W., Hoensch H., Janisch HDInteractions and noninteractions with ranitidine. Clin Pharmacokinet1984;9:493-510
46.
Goelzer SL, Farin-Rush C., Coursin DBRanitidine produces minimal hemodynamic depression in stable intensive care unit patients: a double-blind prospective study. Crit Care Med1988;16(1);8-10
47.
Iberti TJ, Paluch TA, Helmer L., et al.The hemodynamic effects of intravenous cimetidine in intensive care unit patients: a double-blind prospective study. Anesthesiology1986;64(1):87-89
48.
Tryba M., Zevounou F., Torok M., Zenz M.Prevention of acute stress bleeding with sucralfate, antacids, or cimetidine. A controlled trial with pirenzepine as a basic medication. Am J Med1985;79(suppl 2C):55-61
49.
Cannon LA, Heiselman D., Gardner W., Jones J.Prophylaxis of upper gastrointestinal tract bleeding in mechanically ventilated patients. A randomized study comparing the efficacy of sucralfate, cimetidine, antacids. Arch Intern Med1987 ;147: 2101-2106
50.
Lucas CE, Sugawa C., Riddle J., et al. Natural history and surgical dilemma of "stress" gastric bleeding . Arch Surg1971;102: 266-273
