Majid Chammas, MD,
Postdoctoral Research Fellow
University of Miami/Jackson Health
Miami, Florida
Disclosure information not submitted.
Saskya Byerly, MD
Assistant Professor of Surgery
University of Tennessee Health Science Center, United States
Disclosure information not submitted.
Jennifer Lynde, DO
Fellow, Trauma/Surgical Critical Care
University of Miami/Jackson Memorial Hospital, United States
Disclosure information not submitted.
Gerd Pust, MD, FACS,FCCM
Associate Professor of Surgery
Jackson Memorial Hospital - Miller School of Medicine
Miami, Florida, United States
Disclosure information not submitted.
Rishi Rattan, MD
Associate Professor of Surgery
University of Miami Leonard M Miller School of Medicine, United States
Disclosure information not submitted.
Nicholas Namias, MBA, MD, FCCM
Professor of Surgery
University of Miami/Jackson Memorial Hospital, United States
Disclosure information not submitted.
Daniel Yeh, MD, MHPE
Professor
Ryder Trauma Center
Miami, Florida
Disclosure information not submitted.
Title: Role of Stress Ulcer Prophylaxis in Critically Ill Patients Receiving Enteral Nutrition
Introduction: Enteral nutrition (EN) is protective against stress ulcer-related gastrointestinal (GI) bleeding in critically ill patients. We hypothesized that stress ulcer prophylaxis (SUP) provides no additional benefit to EN alone in decreasing the risk of GI bleeding.
Methods: The 2001-2012 Medical Information Mart for Intensive Care (MIMIC-III) database was queried for patients receiving EN within 2 days of ICU admission and the included subjects were divided into two groups depending on receipt of SUP with proton pump inhibitors or histamine H2-receptor antagonists within 2 days of admission. Propensity score matching (1:1) based on vasopressor use and mechanical ventilation was performed. Chi-squared analysis was performed to compare the composite outcome (alive and not requiring endoscopic hemostasis).
Results: A total of 5,994 ICU patients were included, of which 3,914 (65%) received SUP. The mean [SD] age was 64 [15] years, and the majority of patients were men (56%). A total of 853 (41%) in the "EN alone" group were mechanically ventilated on admission, compared to 2,122 (54%) in the "EN+SUP" group (p< 0.001). Patients in the "EN+SUP" were also more likely to be on vasopressors on admission (9.7% vs. 1.3%, p< 0.001). Propensity score matching resulted in 2,080 patients in each group. There were no significant differences in the need for endoscopic hemostasis between the "EN alone" and "EN+SUP" groups (0.9% vs. 1.3%, p=.245). The odds of the composite outcome were also similar between groups (OR=0.91, 95% CI (0.8, 1.1), p=.215).
Conclusion: In the modern era, clinically significant GI bleeding in ICU patients receiving EN within 2 days of admission is rare. There appears to be a selection bias for adding pharmacologic stress ulcer prophylaxis; however, SUP is not associated with increased odds for a clinical benefit. Additional research is required to improve patient selection for SUP.