STRESS-INDUCED GASTRODUODENAL LESIONS AND TOTAL PARENTERAL-NUTRITION IN CRITICALLY ILL PATIENTS - FREQUENCY, COMPLICATIONS, AND THE VALUE OF PROPHYLACTIC TREATMENT - A PROSPECTIVE, RANDOMIZED STUDY

Objective: To assess the frequency, complications, and value of prophylactic treatment of stress-induced gastroduodenal lesions. Design: Patients were prospectively randomized to treatment with total parenteral nutrition, either alone, with sucralfate, or with ranitidine. Setting: A multidisciplinary ICU form 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.