Abstract
Thirty critically ill patients with mixed diagnoses underwent continuous intragastric pH monitoring for 72 hr while confined to a shock/trauma intensive care unit. The first 24 hr were monitored under no specific acid-suppressing therapy (placebo control). During the second and third consecutive 24-hr periods, patients received continuous infusion of intravenous ranitidine in the dose of 6.25 mg/hr and 12.5 mg/hr, respectively. Results of the placebo-control 24-hr study revealed that one third (N=10) of the patients were gastric acid hyposecretors (24-hr median intragastric pH values above pH 4.0). In the normosecreting group (N=20), both ranitidine schedules significantly elevated 24-hr median pH values, when compared to placebo (placebo 24-hr median intragastric pH 1.75; ranitidine 6.25 mg/hr 24-hr median intragastric pH 4.625,P<0.0001; ranitidine 12.5 mg/hr 24-hr median intragastric pH 6.29,P=0.0099). Five patients (18%) failed to adequately respond to the ranitidine 12.5 mg/hr dose (24-hr median intragastric pH<4.0). These findings suggest that a significant percentage of intensive care unit patients are not in need of acid-suppressing therapy as prophylaxis against stress-induced ulceration. Conversely, other patients may require more intensive acid-suppressing regimens because of failure to respond to high dose H2-antagonist therapy.
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References
Lucas CE, Sugawa C, Riddle J, Rector F, Rosenberg B, Walt AJ: Natural history and surgical dilemma of “stress” gastric bleeding. Arch Surg 102:266–273, 1971
Skillman TJ, Bushnell LS, Goldman H, Silen W: Respiratory failure, hypotension, sepsis and jaundice: A clinical syndrome associated with lethal hemorrhage from acute stress ulceration of the stomach. Am J Surg 117:523–530, 1969
Peura DA: Stress-related mucosal damage: An overview. Am J Med 86(6A):3–6, 1987
Hastings PR, Skillman JJ, Bushnell LS, Silen W: Antacid titration in the prevention of acute gastrointestinal bleeding: A controlled, randomized trial of 100 critically ill patients. N Engl J Med 298:1040–1045, 1978
Stothert JC, Siminowitz DA, Dellinger P, Farley M, Edwards WA, Blair AD, Cutler R, Carrico J: Randomized prospective evaluation of cimetidine and antacid control of gastric pH in the critically ill. Ann Surg 192(2):169–174, 1980
Cannon LA, Heiselman D, Gardner W, Jones J: Prophylaxis of upper gastrointestinal tract bleeding in mechanically ventilated patients. A randomized study comparing the efficacy of sucralfate, cimetidine, antacids. Arch Intern Med 147:2101–2106, 1987
Zuckerman GR, Shuman R: Therapeutic goals and treatment options for prevention of stress ulcer syndrome. Am J Med 83(6A):29–35, 1987
Ballesteros MA, Hogan DL, Koss MA, Isenberg JI: Bolus or intravenous infusion of ranitidine: Effects on gastric pH and acid secretion: A comparison of relative cost and efficacy. Ann Intern Med 112:334–339, 1990
Ostro MJ, Russell JA, Soldin SJ, Mahon WA, Jeejeebhoy KN: Control of gastric pH with cimetidine: Boluses versus primed infusions. Gastroenterology 89:532–537, 1985
Sanders SW, Buchi KN, Moore JG, Bishop A: Pharmacodynamics of intravenous ranitidine after bolus and continuous infusion in patients with healed duodenal ulcers. Clin Pharmacol Ther 46(5):545–551, 1989
Basso N, Bagarani M, Materia A, Fiorani S, Lunardi P, Speranza V: Cimetidine and antacid prophylaxis of acute upper gastrointestinal bleeding in high risk patients. Am J Surg 141:339–341, 1981
Peura DA, Johnson LF: Cimetidine for prevention and treatment of gastroduodenal mucosal lesions in patients in an intensive care. Ann Intern Med 103:173–177, 1985
Santucci L, Fiorucci S, Pelli A, Calderazzo L, Morelli A: Control of gastric pH with ranitidine in critically ill patients: Comparison of two intravenous regimens. Dig Dis Sci 36(5):583–587, 1991
Priebe HJ, Skillman JJ, Bushnell LS, Long PC, Silen W: Antacid versus cimetidine in preventing acute gastrointestinal bieeding. N Engl J Med 302:426–430, 1980
Stannard VA, Hutchinson A, Morris DL, Byrne A: Gastric exocrine “failure” in critically ill patients: Incidence and associated features. Br Med J 296:155–156, 1970
Norton L, Greer J, Eiseman B: Gastric secretory response to head injury. Arch Surg 101:200–204, 1970
Czaja AJ, McAlhany JG, Pruitt BA Jr: Acute gastroduodenal disease after thermal injury: An endoscopic evaluation of incidence and natural history. N Engl J Med 291:925–929, 1974
Martin LF, Martin MH, Polk HC: Failure of gastric pH control by antacids or cimetidine in the critically ill: A valid sign of sepsis. Surgery 88:59–69, 1980
Halberg F, Halberg E: Appendix: Terms for methods and facts in chronopharmacology.In Toward Chronopharmcology. R Takahashi, F Halberg, CA Walker (eds). Oxford, Pergamon Press, 1982, pp 391–423
Snedecor GW, Cochran WG: Statistical Methods, 7th ed. Iowa State University Press, Ames, Iowa, 1980, pp 280–282
More DG, Raper RF, Munro IA, Watson CJ, Boutagy JS, Shenfield GM: Randomized, prospective trial of cimetidine and ranitidine for control of intragastric pH in the critically ill. Surgery 97:215–223, 1985
Larson G, Davidson P, Brown J, Wilson T, Bishop A: Comparison of ranitidine versus placebo on 24-hour gastric pH and upper gastrointestinal (UGI) bleeding in head injury patients. Abstract, 54th Annual Meeting of the American College of Gastroenterologists. New Orleans, October 23–25, 1989
Reusser P, Gye K, Scheidegger D, Buchmann B, Buser M, Zimmerli W: Prospective endoscopic study of stress erosions and ulcers in critically ill neurosurgical patients: Current incidence and effect of acid-reducing prophylaxis. Crit Care Med 18(3):270–274, 1990
Knaus WA, Draper EA, Wagner DP, Zimmerman JE: An evaluation of outcome from intensive care in major medical centers. Ann Intern Med 104:410–418, 1986
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Moore, J.G., Clemmer, T.P., Taylor, S. et al. Twenty-four-hour intragastric pH patterns in ICU patients on ranitidine. Digest Dis Sci 37, 1802–1809 (1992). https://doi.org/10.1007/BF01308071
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DOI: https://doi.org/10.1007/BF01308071