Intermittent Intravenous Pantoprazole and Continuous Cimetidine Infusion: Effect on Gastric pH Control in Critically Ill Patients at Risk of Developing Stress-Related Mucosal Disease

Somberg, Lewis B.; Morris, John A.; Fantus, Richard J.; Graepel, Jay; Field, Brian; Lynn, Richard B.; Karlstadt, Robyn G.

doi:10.1097/ta.0b013e31815e40b5

Cited by 45 publications

(36 citation statements)

References 20 publications

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“…Esses fatos e sua potência e disponibilidade de preparações parenterais, fazem dele uma importante arma no controle da DMAE 16 . Um estudo recente 14 14 . Têm-se demonstrado que um pH maior que 4 é suficiente para previnir sangramento GI associado ao estresse.…”

Section: Ibp (Inibidores Da Bomba De Prótons)unclassified

Profilaxia das úlceras associadas ao estresse

Pompílio

Cecconello

2010

ABCD, arq. bras. cir. dig.

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DESCRITORESÚlcera duodenal. Terapêutica. Inibidores da bomba de prótons.RESUMO -Introdução -As úlceras da mucosa gastroduodenal que aparecem após graves insultos têm sido chamadas de úlceras associadas ao estresse ou, mais genericamente, de "doença mucosa associada ao estresse" (DMAE). São conhecidas desde a Antiguidade e apesar de relacionarem-se com altos índices de morbidade e mortalidade, esquemas de profilaxia no intuito de minimizar seus riscos, só foram introduzidos recentemente. Os inibidores da bomba de prótons têm desempenhado papel importante nesse cenário. Métodos -O presente artigo é uma breve revisão sobre seu uso dentro do contexto clínico da profilaxia do sangramento gastrointestinal relacionado ao estresse.ABSTRACT -Introduction -Gastroduodenal mucosal ulcers that appear after severe insults have been called ulcers associated with stress or, more generally, "mucosal disease associated with stress" (DMAE). Are known since antiquity and although linked with high morbidity and mortality, prevention schemes in order to minimize their risk, were introduced only recently. The proton pump inhibitors have played an important role in this scenario. Methods -This article is a brief review of its use within the clinical context of prophylaxis of gastrointestinal bleeding due to stress. INTRODUÇÃOA s úlceras da mucosa gastroduodenal que aparecem após graves insultos -como queimaduras, choque séptico e grandes traumatismos, por exemplo -, têm sido chamadas de úlceras associadas ao estresse ou, mais genericamente, de doença mucosa associada ao estresse (DMAE). São conhecidas desde a Antiguidade e apesar de relacionarem-se com altos índices de morbidade e mortalidade, esquemas de profilaxia no intuito de minimizar seus riscos, só foram introduzidos recentemente. Os inibidores da bomba de prótons (IBP) têm desempenhado um papel importante nesse cenário. O presente artigo é uma breve revisão sobre seu uso dentro do contexto clínico da profilaxia do sangramento gastrointestinal (GI) relacionado ao estresse. Curling, Cushing e AlémA primeira descrição de DMAE foi de Curling em 1842 7 . Esse autor descreveu úlceras duodenais associadas a queimaduras como uma entidade clínica à parte do espectro clássico da doença péptica, embora ele mesmo admita que Dupuytren, dez anos antes, tenha chamado a atenção para ulcerações intestinais em pacientes que sobreviviam de lesões produzidas por queimaduras. Quase um século se passou para que um novo dado pudesse ser acrescentado a essa questão. Segundo Harvey Cushing, foi Carl von Rokitansky quem primeiro chamou a atenção para a associação entre ulceração péptica e lesões cerebrais ou meníngeas. Em seu estudo clássico de 1932 9 , Cushing mostrou onze casos de patologia cerebral nos quais, à autopsia, foram encontradas ulcerações no trato

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Section: Ibp (Inibidores Da Bomba De Prótons)unclassified

Profilaxia das úlceras associadas ao estresse

Pompílio

Cecconello

2010

ABCD, arq. bras. cir. dig.

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“…In these patients, the gastric mucosa becomes ischemic and the protective mucosal barrier becomes disrupted [1,2]. Once the patient is hemodynamically stable, gastric acid secretion increases as the result of a backdiffusion of hydrogen ions.…”

Section: Introductionmentioning

confidence: 98%

“…Aggressive prophylactic pharmacotherapy is also utilized to prevent the formation of stress ulcers. The objective of acid suppression pharmacotherapy in critically ill patients is to maintain a gastric pH > 4.0 as data suggest that bleeding risk and SRMD are reduced when the gastric pH is above this threshold [2,[13][14][15][16]. In addition, clinicians should recognize important SRMD risk factors, such as mechanical ventilation (MV) for >48 h and coagulopathy [17,18].…”

Section: Introductionmentioning

confidence: 99%

“…In addition, patients with head injuries can have hypersecretion of gastric acid related to autonomic dysregulation, increasing the risk of SRMD, including ''Cushing'' ulcers [3][4][5][6][7][8]. This increase in gastric acid secretion results in gastric mucosal damage, and in severe cases, it can lead to significant upper gastrointestinal (GI) bleeding [2].…”

Section: Introductionmentioning

confidence: 99%

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Prospective, Randomized Comparison of Lansoprazole Suspension, and Intermittent Intravenous Famotidine on Gastric pH and Acid Production in Critically ill Neurosurgical Patients

et al. 2010

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“…The administration of various doses of IV pantoprazole (40 mg every 12 or 24 h, and 80 mg every 8, 12 or 24 h) was compared with continuously infused cimetidine (30 mg bolus followed by 50 mg/h). The study found that, on any day, 80 mg of IV pantoprazole given every 8 h or 12 h achieved the greatest percent time where the intragastric pH was >4, but this was matched by 40 mg every 12 h on day 2 of the study [Somberg et al 2008]. This suggests that an initial 80 mg every 8 or 12 h for the first 24 h, followed by 40 mg every 12 h from the second day onwards, may obtain the best acid suppressing results.…”

Section: Cost-effectiveness Of Intravenous Ppi In Bleeding Peptic Ulcersmentioning

confidence: 99%

Review: A clinical guide to using intravenous proton-pump inhibitors in reflux and peptic ulcers

Pang

Graham

2010

Therap Adv Gastroenterol

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Intravenous (IV) proton-pump inhibitors (PPIs) are potent gastric acid suppressing agents, and their use is popular in clinical practice. Both IV and oral PPIs have similarly short half-lives, and their effects on acid secretion are similar, thus their dosing and dosage intervals appear to be interchangeable. The possible exception is when sustained high pHs are required to promote clot stabilization in bleeding peptic ulcers. Continuous infusion appears to be the only form of administration that reliably achieves these high target pHs. IV PPI is indicated in the treatment of high-risk peptic ulcers, complicated gastroesophageal reflux, stress-induced ulcer prophylaxis, ZollingerEllison syndrome, and whenever it is impossible or impractical to give oral therapy. The widespread use of PPIs has been controversial. IV PPIs have been linked to the development of nosocomial pneumonia in the intensive care setting and to spontaneous bacterial peritonitis in cirrhotic patients. This review discusses the use of IV PPI in different clinical scenarios, its controversies, and issues of appropriate use.

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Intermittent Intravenous Pantoprazole and Continuous Cimetidine Infusion: Effect on Gastric pH Control in Critically Ill Patients at Risk of Developing Stress-Related Mucosal Disease

Abstract: This pilot study indicates that intermittent IV pantoprazole effectively controls gastric pH and may protect against UGI bleeding in high risk ICU patients without the development of tolerance.

Cited by 45 publications

References 20 publications

Profilaxia das úlceras associadas ao estresse

Profilaxia das úlceras associadas ao estresse

Prospective, Randomized Comparison of Lansoprazole Suspension, and Intermittent Intravenous Famotidine on Gastric pH and Acid Production in Critically ill Neurosurgical Patients

Review: A clinical guide to using intravenous proton-pump inhibitors in reflux and peptic ulcers

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