• Karim El-Kersh, Bilal Jalil, Stephen A McClave, Rodrigo Cavallazzi, Juan Guardiola, Karen Guilkey, Annuradha K Persaud, Stephen P Furmanek, Brian E Guinn, Timothy L Wiemken, Bashar Chihada Alhariri, Scott P Kellie, and Mohamed Saad.
• University of Louisville School of Medicine, Department of Internal Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Louisville, KY, United States. Electronic address: karim.elkersh@louisville.edu.
• J Crit Care. 2018 Feb 1; 43: 108-113.

PurposeWe investigated whether early enteral nutrition alone may be sufficient prophylaxis against stress-related gastrointestinal (GI) bleeding in mechanically ventilated patients.Materials And MethodsProspective, double blind, randomized, placebo-controlled, exploratory study that included mechanically ventilated patients in medical ICUs of two academic hospitals. Intravenous pantoprazole and early enteral nutrition were compared to placebo and early enteral nutrition as stress-ulcer prophylaxis. The incidences of clinically significant and overt GI bleeding were compared in the two groups.Results124 patients were enrolled in the study. After exclusion of 22 patients, 102 patients were included in analysis: 55 patients in the treatment group and 47 patients in the placebo group. Two patients (one from each group) showed signs of overt GI bleeding (overall incidence 1.96%), and both patients experienced a drop of >3 points in hematocrit in a 24-hour period indicating a clinically significant GI bleed. There was no statistical significant difference in the incidence of overt or significant GI bleeding between groups (p=0.99).ConclusionWe found no benefit when pantoprazole is added to early enteral nutrition in mechanically ventilated critically ill patients. The routine prescription of acid-suppressive therapy in critically ill patients who tolerate early enteral nutrition warrants further evaluation.Copyright © 2017 Elsevier Inc. All rights reserved.

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