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Stress-related mucosal bleeding in critically ill oncology patients
Jeffrey J Bruno1, Todd W Canada, Chris D Wakefield
1Division of Pharmacy, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030-4009, USA. jjbruno@mdanderson.org
Objective:
To determine the incidence of stress-related mucosal bleeding (SRMB) in a critically ill oncology population receiving stress ulcer prophylaxis (SUP) with either a histamine-2 receptor antagonist (H2RA) or proton pump inhibitor (PPI).
Design:
Single-center, prospective, observational study.
Setting:
Fifty-two bed medical-surgical intensive care unit of an academic oncology institution.
Patients:
A convenience sample of 100 medical and surgical critically ill oncology patients who received intensive care for more than 24 hours and at least one dose of a H2RA or PPI for prevention of SRMB.
Interventions:
None.
Measurements And Main Results:
Patients were followed throughout their intensive care unit stay for the development of an overt and/or clinically significant gastrointestinal (GI) bleed. More patients received a PPI (n=81) in contrast to a H2RA (n=19) for SUP. Overall, 94 patients (94%) had at least one risk factor for a SRMB with four patients (4%) experiencing an event (overt bleed, n=3; clinically significant bleed, n=1). All cases of GI bleeding occurred in patients receiving a PPI. No ICU deaths were considered directly related to a GI bleed.
Conclusions:
The incidence of SRMB among high-risk critically ill oncology patients receiving SUP appears low; further, large-scale trials are needed to confirm this finding.
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