The intervention under investigation was stress ulcer prophylaxis with PPI compared to H2RA in the prevention of UGI bleeding associated with SRMD.
The literature review identified seven randomised, controlled trials (RCT) comparing H2RA and PPI in the prevention of UGI bleeding associated with SRMD (10-16) and three individual meta-analyses (17-19).
0, a level which has previously been found to be effective in preventing bleeding from SRMD (21).
The early year of publication (1997) has been noted as a possible cause, as advances in critical care medicine such as early enteral feeding have been demonstrated to reduce SRMD (23).
Lin et al analysed results from seven RCTs comparing PPIs with H2RAs for the prevention of UGI bleeding from SRMD in a total population of 936 patients (17) (Table 1).
Upper GI haemorrhage secondary to SRMD is a relatively uncommon complication in modern critical care medicine as demonstrated by the low incidence reported in the aforementioned series.
It was therefore suggested that early enteral feeding would be beneficial in preventing UGI bleeding secondary to SRMD.
Furthermore, despite no prophylactic acid suppressive therapy, there was no incidence of UGI bleeding, prompting the authors to conclude that not only was early enteral feeding safe but was also effective in preventing UGI bleeding from SRMD.
A total of 144 patients with the presence of risk factors for SRMD listed in the Table were enrolled in the study; 74 patients were randomized to receive cimetidine 800 mg by mouth at bedtime versus sucralfate 1 g by mouth every 6 hours.
One major limitation of the study is that more risk factors for SRMD were present at baseline in the ranitidine group than in the omeprazole group (2.
Sixty-six percent of patients were on AST without any indication or risk for SRMD, and 52% of patients were inappropriately transferred to a medicine floor with AST The percentage of inappropriate initiation of AST in the ICU at BUMC is consistent with the studies by Nardino et al (17) and Zink et al (18).
SRMD can lead to significant morbidity in ICU patients.