| Stress ulcers and organ failure in intubated patients in surgical intensive care units. | |
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MedLine Citation:
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PMID: 1558413 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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This study compared prophylactic administration of either intragastric misoprostol (200 micrograms four times a day), a prostaglandin E1 analog, or bolus intravenous cimetidine (300 mg every 6 hours) in preventing stress lesions and stress bleeding in 127 adult postoperative patients who required mechanical ventilation and also had developed hypotension or sepsis. Both drug treatments were equally effective in preventing the development of diffuse gastritis (greater than 10 gastric hemorrhagic lesions) and in preventing upper gastrointestinal hemorrhage (UGIH). The combined data from both groups showed that for the 44 (35%) patients who died, death was significantly associated with the presence at study entry of renal failure (64% of 25 patients with renal failure died), hepatic failure (57% of 23 patients) or coagulopathy (62% of 29 patients) (p less than 0.02 for each), and with the number of organ system failures at study entry (48% of 69 patients with multiple organ system failures died, p less than 0.001). Death was also significantly associated with the presence of adult respiratory distress syndrome (ARDS) at study entry or the development of ARDS (63% of 24 patients with ARDS died, p less than 0.001), and the development of UGIH (5% of 93 patients with known bleeding outcome died, p less than 0.05). The number of stress lesions that developed was significantly associated with subsequent UGIH (p less than 0.001). Additional organ system failure developed during the study in 31% of the 127 patients, as did diffuse gastritis in 20% of 111 patients who had a follow-up endoscopy. These results demonstrate that postoperative patients who require mechanical ventilation and have hypotension or sepsis are at significant risk for the development of stress gastric lesions and multiple organ system failure even when prophylaxis for stress ulcers is provided. Furthermore, the presence of ARDS, renal failure, hepatic failure, coagulopathy, and UGIH are significantly associated with death. |
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Authors:
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L F Martin; F V Booth; H D Reines; L G Deysach; R L Kochman; L J Erhardt; G S Geis |
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Publication Detail:
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Type: Clinical Trial; Journal Article; Multicenter Study; Randomized Controlled Trial |
Journal Detail:
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Title: Annals of surgery Volume: 215 ISSN: 0003-4932 ISO Abbreviation: Ann. Surg. Publication Date: 1992 Apr |
Date Detail:
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Created Date: 1992-05-01 Completed Date: 1992-05-01 Revised Date: 2010-09-07 |
Medline Journal Info:
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Nlm Unique ID: 0372354 Medline TA: Ann Surg Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 332-7 Citation Subset: AIM; IM |
Affiliation:
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Department of Surgery, Milton S. Hershey Medical Center, Hershey, Pennsylvania 17033. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Cause of Death Cimetidine / therapeutic use Double-Blind Method Female Follow-Up Studies Gastroscopy Humans Intensive Care* Male Middle Aged Misoprostol / therapeutic use Multiple Organ Failure / complications*, prevention & control Peptic Ulcer / prevention & control* Peptic Ulcer Hemorrhage / prevention & control* Placebos Pneumonia / etiology Postoperative Complications Prospective Studies Respiratory Distress Syndrome, Adult / complications Stress, Physiological / complications* Surgical Procedures, Operative / adverse effects* Survival Rate Treatment Outcome Wound Healing |
| Chemical | |
Reg. No./Substance:
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0/Placebos; 51481-61-9/Cimetidine; 59122-46-2/Misoprostol |
| Comments/Corrections | |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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