Stress-related mucosal bleeding in critically ill oncology patients

Abstract

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). Single-center, prospective, observational study. Fifty-two bed medical-surgical intensive care unit of an academic oncology institution. 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. None. 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. 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.