BACKGROUND/AIMS: Critically ill patients especially who require mechanical ventilation or have coagulopathy are at increased risk for stress-related gastrointestinal hemorrhage. There are conflicting data on the efficacy and complication rates of various prophylactic regimens. METHODOLOGY: Our single-center randomized, placebo-controlled study included 287 patients with high risk for stress-related upper gastrointestinal hemorrhage (>48 h mechanical ventilation, coagulopathy). We compared 3 prophylactic regimens (proton pump inhibitor--omeprazole 40 mg i.v. once daily, n=72; H2 antagonists--famotidine 40 mg twice a day, n=71; and sucralfate 1 g every 6 hours, n=69) with placebo (n=75) in patients with trauma or after major surgery. RESULTS: Of 287 assessable patients, clinically significant stress-related upper gastrointestinal bleeding was observed in 1%, 3%, 4%, and 1% of patients assigned to receive omeprazole, famotidine, sucralfate, and placebo, respectively (p>0.28). Bleeding developed significantly more often in patients with coagulopathy compared with the others (10% vs. 2%; p=0.006). The gastric pH (p>0.001) and gastric colonization (p<0.05) was significantly higher in the patients who received pH increasing substances when compared with the other 2 groups. Nosocomial pneumonia occurred in 11% of patients receiving omeprazole, in 10% of famotidine patients, in 9% of sucralfate patients and in 7% of controls (p>0.34). No statistically significant differences were found for days on ventilator, length of ICU stay, or mortality among all the 4 groups. CONCLUSIONS: We could not show that omeprazole, famotidine, or sucralfate prophylaxis can affect already very low incidence of clinically important stress-related bleeding in high-risk surgical intensive care unit patients. Furthermore, our data suggested that especially gastric pH increasing medication could increase the risk for nosocomial pneumonia. Routine prophylaxis for stress-related bleeding even in high-risk patients seems not to be justified.

• MeSH
• antagonisté histaminu H2 terapeutické užití   MeSH
• Bacteria izolace a purifikace   MeSH
• famotidin terapeutické užití   MeSH
• fyziologický stres komplikace   MeSH
• gastrointestinální krvácení epidemiologie   etiologie   prevence a kontrola   MeSH
• infekce spojené se zdravotní péčí komplikace   epidemiologie   MeSH
• inhibitory protonové pumpy * MeSH
• kritický stav MeSH
• lidé středního věku MeSH
• lidé MeSH
• omeprazol terapeutické užití   MeSH
• peptický vřed komplikace   etiologie   prevence a kontrola   MeSH
• pneumonie komplikace   epidemiologie   MeSH
• protivředové látky terapeutické užití   MeSH
• senioři MeSH
• stanovení žaludeční acidity MeSH
• sukralfát terapeutické užití   MeSH
• žaludek mikrobiologie   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• klinické zkoušky MeSH
• práce podpořená grantem MeSH
• randomizované kontrolované studie MeSH
• srovnávací studie MeSH
• Názvy látek
• antagonisté histaminu H2 MeSH
• famotidin MeSH
• inhibitory protonové pumpy * MeSH
• omeprazol MeSH
• protivředové látky MeSH
• sukralfát MeSH