The Prophylactic Effect of Proton Pump Inhibitors Combined with Enteral Nutrition for Preventing Gastrointestinal Hemorrhage after Cardiovascular Surgery in High-Risk Patients
DOI:
https://doi.org/10.1532/hsf.2279Abstract
Background: Gastrointestinal hemorrhage (GH) is one of the most serious complications after cardiovascular surgery. The aim of the study was to provide an optimal therapeutic strategy for preventing postoperative GH in high-risk patients. Methods: This retrospective case-control study included 188 adult patients at high risk of postoperative GH. These patients were divided into two groups based on a strategy for preventing postoperative GH: Group A
(n = 97) received continuous intravenous infusion of proton-pump inhibitor (PPI) combined with early enteral nutrition, and Group B (n = 91) received a bolus intravenous infusion of PPI combined with late enteral nutrition. The clinical features of the groups were examined.
Results: The incidence of postoperative GH in the patients of group A was significantly lower than the patients in group B. The duration from the end of surgery to eating for the first time in the patients of group A was significantly shorter than in the patients of group B. A descending trend in 30-day mortality was observed in the patients of group A compared with group B, but no significant difference was found between the two groups.
Conclusion: Continuous intravenous infusion of PPI combined with early enteral nutrition could effectively prevent GH and reduce 30-day mortality after cardiovascular surgery in high-risk patients.
References
Ait Houssa M, Selkane C, Moutaki Allah Y, et al. 2007. Upper digestive bleedings after cardiac surgery. Ann Cardiol Angeiol (Paris). 56:126-9.
Andersson B, Nilsson J, Brandt J, et al. 2005. Gastrointestinal complications after cardiac surgery. Br J Surg 92:326-33.
Andersson B, Andersson R, Brandt J, Höglund P, Algotsson L, Nilsson J. 2010. Gastrointestinal complications after cardiac surgery - improved risk stratification using a new scoring model. Interact Cardiovasc Thorac Surg 10:366-70.
Chaudhry R, Zaki J, Wegner R, et al. 2017. Gastrointestinal complications after cardiac surgery: A nationwide population-based analysis of morbidity and mortality predictors. J Cardiothorac Vasc Anesth 31:1268-74.
Chwiesko A, Charkiewicz R, Niklinski J, et al. 2016. Effects of different omeprazole dosing on gastric pH in non-variceal upper gastrointestinal bleeding: A randomized prospective study. J Dig Dis 17:588-99.
D’Ancona G, Baillot R, Poirier B, et al. 2003. Determinants of gastrointestinal complications in cardiac surgery. Tex Heart Inst J 30:280-5.
Fan H, Zheng Z, Feng W, et al. 2010. Risk factors and prevention of upper gastrointestinal hemorrhage after a coronary artery bypass grafting operation. Surg Today 40:931-5
Grus T, Rohn V, Brlicová L, et al. 2014. Gastrointestinal complications after cardiac surgery: eight years experience in a single center. Acta Chir Belg 114:332-7.
Krawiec F, Maitland A, Duan Q, Faris P, Belletrutti PJ, Kent WDT. 2017. Duodenal ulcers are a major cause of gastrointestinal bleeding after cardiac surgery. J Thorac Cardiovasc Surg 154:181-8.
Lee SH, Jang JY, Kim HW, et al. 2014. Effects of early enteral nutrition on patients after emergency gastrointestinal surgery: a propensity score matching analysis. Medicine 93:e323.
Lewis SJ, Andersen HK, Thomas S. 2009. Early enteral nutrition within 24 h of intestinal surgery versus later commencement of feeding: a systematic review and meta-analysis. J Gastrointest Surg 13:569-75.
Madsen KR, Lorentzen K, Clausen N, et al. 2014. Danish Society of Intensive Care Medicine; Danish Society of Anesthesiology and Intensive Care Medicine. Guideline for stress ulcer prophylaxis in the intensive care unit. Dan Med J 61:C4811.
Marik PE, Vasu T, Hirani A, et al. 2010. Stress ulcer prophylaxis in the new millennium: a systematic review and meta-analysis. Crit Care Med 38:2222-8.
Ohri SK, Velissaris T. 2006. Gastrointestinal dysfunction following cardiac surgery. Perfusion 21:215-23.
Patel AJ, Som R. 2013. What is the optimum prophylaxis against gastrointestinal haemorrhage for patients undergoing adult cardiac surgery: histamine receptor antagonists, or proton-pump inhibitors? Interact Cardiovasc Thorac Surg. 16:356-60.
Perugini RA, Orr RK, Porter D, et al. 1997. Gastrointestinal complications following cardiac surgery. An analysis of 1477 cardiac surgery patients. Arch Surg 132:352-7.
Quenot JP, Thiery N, Barbar S. 2009. When should stress ulcer prophylaxis be used in the ICU? Curr Opin Crit Care 15:139-43.
Rodriguez R, Robich MP, Plate JF, et al. 2010. Gastrointestinal complications following cardiac surgery: a comprehensive review. J Card Surg 25:188-97.
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