Epinephrine Dose Has a Preventive Effect on the Occurrence of Stress Ulcer-Induced Gastrointestinal Bleeding in Critically Ill Patients
- 135 Downloads
Epinephrine may impair splanchnic blood flow, but the impact of epinephrine dose on the occurrence of clinically significant gastrointestinal bleeding (CSGB) caused by stress ulcer remains unclear. We investigated the effect of epinephrine dose on the occurrence of stress ulcer-related CSGB in intensive care unit (ICU) patients.
In this prospective, observational, cohort study conducted in a French teaching hospital, 40 consecutive ICU patients receiving epinephrine infusion in whom a stress ulcer was diagnosed by an upper gastrointestinal endoscopy were included, from February 2010 to July 2015. The effects of epinephrine dose, and other covariates, on the occurrence of stress ulcer-related CSGB were analyzed using a multiple logistic regression model for repeated measures: At each observation, each patient serves as his own control.
A total of 1484 time-dependent epinephrine dose modifications were available for analysis. The median epinephrine dose rate was 0.8 (0–9.5) mg/h, and the median epinephrine cumulative dose was 44.8 (2.6–2343) mg. Epinephrine, expressed as the average dose per day at time t, had a significant protective effect on the occurrence of stress ulcer (odds ratio 0.22; 95% confidence interval (CI), 0.12–0.38; p < 0.0001, for a log10 increase of epinephrine dose). Enteral feeding had also a protective effect (odds ratio 0.55; 95% CI 0.41–0.72; p < 0.0001, for a log10 increase of kcal/day). Only renal replacement therapy increased the occurrence of stress ulcer in the model.
An increase in the average dose of epinephrine per day increased the time to occurrence of stress ulcer in critically ill patients.
KeywordsEpinephrine dose Stress ulcer Critically ill patients Gastrointestinal bleeding Enteral nutrition
We are indebted to Hélène Owczarek, from the medical intensive care unit of the European Georges Pompidou Hospital, for managing intensive care unit database.
AB is the guarantor of article. AB, SU, MB, and CF contributed to conception and study design, data collection and analysis, and drafting and revising of the manuscript. AB, SU, MB, and CF approved the final version of the article.
Compliance with ethical standards
Conflict of interest
None. This work was not sponsored by gifts or fellowships.
- 13.Nelson DP, Samsel RW, Wood LD, Schumacker PT. Pathological supply dependence of systemic and intestinal O2 uptake during endotoxemia. J Appl Physiol Bethesda Md. 1985;1988:2410–2419.Google Scholar
- 14.Wang P, Ba ZF, Chaudry IH. Hepatic extraction of indocyanine green is depressed early in sepsis despite increased hepatic blood flow and cardiac output. Arch Surg Chic Ill. 1960;1991:219–224.Google Scholar
- 21.Therneau TM. Modeling Survival Data: Extending the Cox Model. Springer. [cited 2017 Mar 16]. Available from: http://www.springer.com/gp/book/9780387987842.
- 26.Krag M, Perner A, Wetterslev J, Wise MP, Hylander Møller M. Stress ulcer prophylaxis versus placebo or no prophylaxis in critically ill patients. A systematic review of randomised clinical trials with meta-analysis and trial sequential analysis. Intensive Care Med. 2014;40:11–22.CrossRefPubMedGoogle Scholar