The results of intragastric рH-monitoring related to stress ulcer prophylaxis method in comatose patients

  • U.A. Fesenko The Danylo Halytsky National Medical University in Lviv
  • K.M. Loboyko Regional Clinical Hospital in Kharkiv
Keywords: stress ulcer prophylaxis, intragastric рН, coma, brain stroke

Abstract

Aim. Analyzing dynamics of intragastric рН related to stress ulcer prophylaxis method in comatose patients. 

Materials and Methods. The prospective study included 100 comatose patients with brain stroke with consciousness level of 5-8 by Glasgow Coma Scale. All patients were given tube enteral nutrition . The patients were divided into three groups: group HB (n=18) received Н-2-histamine blocker agent; group IPI (n=38) received ion pump inhibitor, and group EN (n=44) received no medication  for stress ulcer prophylaxis. The maximal, minimal and average daily intragastric рН levels were analyzed on the 1st, 3rd, and 5th  days of stay in the intensive care unit. 

Results and Discussion. The average daily intragastric pH level in group HB was 2,4±0,44 on day 1,- 4,54±1,5 on day 3, and- 3,85±0,77 on day 5. This parameter in the group IPI was 1,66±0,45 on day 1, 5,9±1,43 on day 3, and 5,37±1,44 on day 5; in the group EN: 2,98±0,65 on day 1,- 3,41±0,45 on day 3, and 3,45±0,5 on day 5. 

Conclusions. Early enteral nutrition ensures the optimal level of intragastric pH. The ion pump inhibitors provide more potent inhibition of acidity of gastric content compared to the Н-2-histamine blocker agents. Intragastric рН-monitoring is useful in evaluating the stress ulcer prophylaxis effectiveness in comatose patients.

References

Zha AM, Sari M, Torbey MT. Recommendations for management of large hemispheric infarction. Curr Opin Crit Care 2015,21:91-98.

Flower O., Smith M. The acute management of intracerebral hemorrhage. Current Opinion in Critical Care 2011,17:106-114.

Krag M, Perner A, Wetterslev J, et al. Prevalence and outcome of gastro-intestinal bleeding and use of acid suppressants in acutely ill adult intensive care patients. Intensive Care Med 2015; 41:833-845.

Krag M, Perner A, Muller MH. Stress ulcer prophylaxis in the intensive care unit. Curr Opin Crit Care 2016, 22:186-190.

Quenot JP, Thiery N, Barbar S. When should stress ulcer prophylaxis be used in the ICU? Curr Opin Crit Care 2009,15:139-143.

Frandah W, Colmer-Hamood J, Nugent K, et al. Patterns of use of prophylaxis for stress-related mucosal disease in patients admitted to the intensive care unit. J Intensive Care Med 2013; 29:96-103.

Krag M, Perner A, Wetterslev J, et al. Stress ulcer prophylaxis in the intensive care unit: an international survey of 97 units in 11 countries. Acta Anaesthesiol Scand 2015; 59:576-585.

Charlot M, Ahlehoff O, Norgaard ML, et al. Proton-pump inhibitors are associated with increased cardiovascular risk independent of clopidogrel use: a nationwide cohort study. Ann Intern Med 2010;153:378-386.

Blaser AR, Jakob SM, Starkopf J. Gastrointestinal failure in the ICU. Curr Opin Crit Care 2016,22:128-141.

Bhattacharyya T, Sarbapalli D, Pal R, et al. Evaluating ranitidine, pantoprazole and placebo on gastric pH in elective surgery. Saudi J Anaesth. 2011;5(1):67-72.

Wijdicks EF, Sheth KN, Carter BS, et al., American Heart Association Stroke Council. Recommendations for the management of cerebral and cerebellar infarction with swelling: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2014;45:1222-1238.

Published
2016-12-28
How to Cite
Fesenko, U., & Loboyko, K. (2016). The results of intragastric рH-monitoring related to stress ulcer prophylaxis method in comatose patients. Acta Medica Leopoliensia, 22(4), 27-31. Retrieved from https://amljournal.com/index.php/journal/article/view/173