The virtual absence of stress-ulceration related bleeding in ICU patients receiving prolonged mechanical ventilation without any prophylaxis. A prospective cohort study

Abstract

Objective: To study the incidence of stress-ulcer related bleeding in ICU patients receiving prolonged (> 2 days) mechanical ventilation without any stress ulceration prophylaxis.

Design: A prospective cohort study in 183 patients.

Interventions: All patients received clinical treatment including maintenance of adequate tissue perfusion (with low dose inotropes and vasodilators), infection prevention (by selective decontamination of the digestive tract) throughout ICU stay and suppression of generalized inflammatory reaction (by steroids).

Setting: Medical/surgical ICU of a major teaching hospital in Amsterdam (Onze Lieve Vrouwe Gasthuis).

Measurements and results: 167 patients were evaluated during 2182 treatment days in the ICU and during 1753 days on mechanical ventilation without stress ulceration prophylaxis. The mean total risk score for stress ulceration related bleeding was 38 (Tryba score). Stress ulceration related bleeding developed in 1 patient (0.6%).

Conclusions: The incidence of SURB was less then 1% in this cohort of ICU patients receiving longterm mechanical ventilation with a high risk for SURB (mean total risk score 38). All patients received agressive shock resuscitation, infection prevention with selective decontamination of the digestive tract (SDD) and suppression of inflammatory response with steroids. Further studies are needed to evaluate the contribution of each of these elements of the integral approach.