General Surgery Intensive Care Unit Research Articles

The effectiveness of gastric pH control with bolus famotidine versus cimetidine for stress ulcer prophylaxis in a surgical intensive care unit

Our study examined the effectiveness of a potent histamine 2-receptor antagonist, famotidine, in gastric pH control, compared with that of cimetidine, using intermittent bolus administrative for stress ulcer prophylaxis. A total of 48 patients who were admitted into the general surgery intensive care unit for a minimum of 3 days and who required mechanical ventilation were included in the study. Each patient participated in three different regimens (cimetidine 200 mg every 4 hours, cimetidine 400 mg every 4 hours, and famotidine 20 mg every 8 hours, in six randomized sequences) on 3 consecutive days. Intragastric pH was measured by use of a continuous pH-monitoring system. Median gastric pH, the percentage of time pH was >4, and the frequency distribution of gastric pH values during the treatment period were measured. No significant improvements in gastric pH were measured and percentage of time that pH was >4 occurred when the patients received cimetidine 400 mg every 4 hours, compared with cimetidine 200 mg every 4 hours ( P = 0.49 and 0.17, respectively). Gastric pH and percentage of time pH was >4 were significantly better when patients received famotidine 20 mg every 8 hours, as compared with both the cimetidine 200-mg and cimetidine 400-mg regimens (gastric pH: P = 0.0009 for the 200-mg dose and P = 0.019 for the 400-mg dose; percentage of time pH was >4: P < 0.0001 for the 200-mg dose and P = 0.019 for the 400-mg dose). The effective duration of action (percentage of time pH was >4) for each dose regimen was: cimetidine 200 mg, 1.4 hours; cimetidine 400 mg, 1.8 hours; and famotidine 20 mg, 4.8 hours. The bolus regimen of famotidine achieved a more effective and consistent pH control than the cimetidine regimens for stress ulcer prophylaxis in critically ill patients. It also required less-frequent injections than cimetidine, thus reducing nursing demand; however, in high-risk patients or those with active stress ulcer bleeding, a 6-hour dose schedule may afford better control.

APACHE II Score Does Not Predict Multiple Organ Failure or Mortality in Postoperative Surgical Patients

A clinical study was undertaken to evaluate the ability of the APACHE (acute physiology and chronic health care) II system to predict the development of multiple organ failure syndrome and subsequent mortality. The study was conducted in a university general surgery intensive care unit using the admission APACHE II score. Over a 1-year period, 92 patients qualified for the study, 24 of whom survived, 69 of whom suffered multiple organ failure syndrome, and 68 of whom died. The APACHE II score did not predict the development of multiple organ failure syndrome or mortality with clinical utility and significantly underestimated the potential for the development of multiple organ failure syndrome. Factors that did predict the development of multiple organ failure syndrome and mortality were the time-dependent changes in the PaO2-to-fraction of inspired oxygen ratio and serum lactate, creatinine, and bilirubin levels. Better markers of cell injury are needed for use in decision making and quality assurance analysis in surgical patients.