Alimentary TractDuodenogastroesophageal reflux and esophageal mucosal injury in mechanically ventilated patients☆
Section snippets
Patients
Twenty-six patients hospitalized in a medical intensive care unit were prospectively included in the study. Patients were eligible if they were receiving mechanical ventilator support with endotracheal intubation for at least 48 hours but no longer than 8 days, if they had been fitted with nasogastric tubes since intubation, if they had serum bilirubin levels of <1.4 mg/dL, and if they were not yet receiving enteral nutrition at the time of the study. Exclusion criteria included previous
General
Of the 26 patients enrolled in the study, only 25 could be included in the final analysis because 1 patient extubated himself 4 hours after placement of the probes. Various parameters characterizing the patients are summarized in Table 1.
Variable Patients (n = 25) Age (yr)/sex 65 ± 14/15 men APACHE II score 21 ± 7 Number of organ failures 2.3 ± 1 PEEP (cm H2O) 5.5 ± 3.1 Days of mechanical ventilation 5 ± 2 Intra-abdominal pressure (mm Hg) 8.1 ± 4.5 Volume
Discussion
This study was motivated by an earlier report in which esophagitis was observed to be the most frequent cause of gastrointestinal bleeding in critically ill patients hospitalized in a medical intensive care unit, namely, in 30.7% of the patients with upper gastrointestinal bleeding.1 Esophagitis was associated with the presence of a nasogastric tube in more than 90% of patients. In patients without esophagitis, a nasogastric tube was present in fewer than 60% of cases. The authors concluded
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Address requests for reprints to: Alexander Wilmer, M.D., Department of General Internal Medicine, UZ Gasthuisberg, Herestraat 49, 3000 Leuven 1, Belgium. e-mail: [email protected]; fax: (32) 16-344230.