GI Complications in Patients Receiving Mechanical Ventilation

Mutlu, Go ̈khan M.; Mutlu, Ece; Factor, Phillip

doi:10.1378/chest.119.4.1222

Cited by 319 publications

(276 citation statements)

References 219 publications

(250 reference statements)

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“…Other reasons for prophylaxis mentioned in this study were head trauma, major burns, status post neurosurgical intervention, and organ transplantation; these have also been mentioned as reasons in other studies. 18 A lack of precise criteria for indicating prophylaxis in adults has also been established: one study showed that 25.7% of high-risk patients were not given SU prophylaxis even as 71.4% of low-risk patients received it. 16 Studies have shown that critical care specialists are aware of the risk factors associated with SU in ICU patients.…”

Section: Discussionmentioning

confidence: 99%

Profilaxia para úlcera de estresse em pacientes internados em UTI pediátrica

Araújo¹,

Vieira²,

Carvalho³

2010

J. Pediatr. (Rio J.)

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Objective: To assess use of stress ulcer prophylaxis in patients admitted to five pediatric intensive care units (PICUs) in Porto Alegre, Brazil.Methods: This was a multicenter, prospective, cross-sectional observational study. PICUs were visited on randomly defined days between April 2006 and February 2007, and the medical records of admitted patients were reviewed. Patients whose records had been previously assessed were excluded, as were those with upper gastrointestinal bleeding on admission. Data were collected on age, gender, admission diagnosis, severity of illness, administration of stress ulcer prophylaxis, rationale for prophylaxis, and first-line prophylactic agent of choice. Variables were described as absolute and relative frequencies, mean and standard deviation, or median and interquartile range as appropriate. Pearson's chi-square test for linear trend or Fisher's exact test were used to assess possible associations. The level of significance was set at 5% (p ≤ 0.05).Results: 398 patients (57% male) were assessed [median age, 16 months (IQR 4-65); median length of PICU stay, 4 days (IQR 1-9)]. Respiratory illness was the main reason for admission (32.7%). Most patients received stress ulcer prophylaxis (77.5%; range, 66-91%). Mechanical ventilation (22.3%) was the most common rationale provided, followed by informal routine use of prophylaxis (21.4%). Only one of the participating PICUs had a specific care protocol for use of stress ulcer prophylaxis. Ranitidine was the most commonly used drug (84.5% of cases). Evidence of minor gastrointestinal bleeding was found in 3% of patients; none had clinically significant bleeds. Conclusions:Administration of stress ulcer prophylaxis is a common practice in the participating PICUs, with ranitidine the most commonly used drug. Among the various rationales provided, mechanical ventilation and informal routine use were the most prevalent.J Pediatr (Rio J). 2010;86(6):525-530: Gastroduodenal ulcer, prophylaxis, children, intensive care, gastrointestinal bleeding.

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Section: Discussionmentioning

confidence: 99%

Profilaxia para úlcera de estresse em pacientes internados em UTI pediátrica

Araújo¹,

Vieira²,

Carvalho³

2010

J. Pediatr. (Rio J.)

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“…In other studies, these lesions were described in 24% to 100% of critical patients' procedures within the first 24 hours after ICU admission. (2) As main GIT lesions triggering mechanisms, cell hypoxia and inflammatory mediators release, apoptosis and necrosis, specially in sepsis, in addition to acid and pepsin secretions changes are discussed. (28,29) This study has several limitations, but probably the most important regards the lack of a more objective GID definition.…”

Section: Discussionmentioning

confidence: 99%

“…(1) Mucosal injuries and functional gastrointestinal tract (GIT) changes may be a consequence of the circulatory shock, surgical or traumatic stress, and long term broad spectrum antibiotics use. (2)(3)(4)(5) GID is associated with …”

Section: Introductionmentioning

confidence: 99%

Disfunção do trato gastrointestinal prolongada em pacientes admitidos na terapia intensiva

Lobo¹,

Miranda²

2010

Rev. bras. ter. intensiva

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“…Enteral nutrition is preferred method of nutritional support during critical illness given its major benefit in preserving intestinal mucosal barrier function, cheap and has significantly fewer infective complications as compared to total parenteral nutrition [1][2][3][4][5][6] . Unfortunately, gastrointestinal motility is frequently impaired in these patients and consequently, naso-gastric (NG) feeding cannot be tolerated in approximately 50% patients [1][2][3] due vomiting, feed reflux or regurgitation, pulmonary aspiration [3][4][5] .…”

Section: Introductionmentioning

confidence: 99%

“…Unfortunately, gastrointestinal motility is frequently impaired in these patients and consequently, naso-gastric (NG) feeding cannot be tolerated in approximately 50% patients [1][2][3] due vomiting, feed reflux or regurgitation, pulmonary aspiration [3][4][5] . Not only these feeding complications are associated with higher morbidity and mortality [4][5][6] , they also prevent adequate delivery of nutrition to meet the daily caloric requirement of these patients.…”

Section: Introductionmentioning

confidence: 99%

Pharmacological therapy of feed intolerance in the critically ills

Nguyen¹

2014

WJGPT

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Feed intolerance in the setting of critical illness is associated with higher morbidity and mortality, and thus requires promptly and effective treatment. Prokinetic agents are currently considered as the first-line therapy given issues relating to parenteral nutrition and postpyloric placement. Currently, the agents of choice are erythromycin and metoclopramide, either alone or in combination, which are highly effective with relatively low incidence of cardiac, hemodynamic or neurological adverse effects. Diarrhea, however, can occur in up to 49% of patients who are treated with the dual prokinetic therapy, which is not associated with Clostridium difficile infection and settled soon after the cessation of the drugs. Hence, the use of prokinetic therapy over a long period or for prophylactic purpose must be avoided, and the indication for ongoing use of the drug(s) must be reviewed frequently. Second line therapy, such as total parenteral nutrition and post-pyloric feeding, must be considered once adverse effects relating the prokinetic therapy develop.© 2014 Baishideng Publishing Group Inc. All rights reserved. Key words: Adverse effects; Critical illness; Enteral feeding; Feed intolerance; Prokinetic therapyCore tip: Feed intolerance during critical illness must be promptly recognized and treated due to the associated morbidity and mortality. The current first line treatment for feed intolerance is prokinetic therapy with erythromycin and metoclopramide (alone or in combination), which are highly effective and free of significant adverse effects. Although diarrhoea occurs commonly after combination prokinetic therapy, it is not associated with Clostridium difficile colitis and settled shortly after stopping the treatment. The use of prokinetic therapy over a long period or for prophylactic purpose, therefore, must be avoided and the indication for ongoing use of the drug(s) should be frequently reviewed.Nguyen NQ. Pharmacological therapy of feed intolerance in the critically ills.

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GI Complications in Patients Receiving Mechanical Ventilation

Cited by 319 publications

References 219 publications

Profilaxia para úlcera de estresse em pacientes internados em UTI pediátrica

Profilaxia para úlcera de estresse em pacientes internados em UTI pediátrica

Disfunção do trato gastrointestinal prolongada em pacientes admitidos na terapia intensiva

Pharmacological therapy of feed intolerance in the critically ills

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