Original Article
A Comparison of Sucralfate and Ranitidine for the Prevention of Upper Gastrointestinal Bleeding in Patients Requiring Mechanical Ventilation
N Engl J Med 1998; 338:791-797March 19, 1998
- Abstract
Background
Critically ill patients who require mechanical ventilation are at increased risk for gastrointestinal bleeding from stress ulcers. There are conflicting data on the effect of histamine H2-receptor antagonists and the cytoprotective agent sucralfate on rates of gastrointestinal bleeding, ventilator-associated pneumonia, and mortality.
Methods
In a multicenter, randomized, blinded, placebo-controlled trial, we compared sucralfate with the H2-receptor antagonist ranitidine for the prevention of upper gastrointestinal bleeding in 1200 patients who required mechanical ventilation. Patients received either nasogastric sucralfate suspension (1 g every six hours) and an intravenous placebo or intravenous ranitidine (50 mg every eight hours) and a nasogastric placebo.
Results
The patients in the two groups had similar base-line characteristics. Clinically important gastrointestinal bleeding developed in 10 of 596 (1.7 percent) of the patients receiving ranitidine, as compared with 23 of 604 (3.8 percent) of those receiving sucralfate (relative risk, 0.44; 95 percent confidence interval, 0.21 to 0.92; P = 0.02). In the ranitidine group, 114 of 596 patients (19.1 percent) had ventilator-associated pneumonia, as compared with 98 of 604 (16.2 percent) in the sucralfate group (relative risk, 1.18; 95 percent confidence interval, 0.92 to 1.51; P = 0.19). There was no significant difference between the groups in mortality in the intensive care unit (ICU) (23.5 percent in the ranitidine group and 22.8 percent in the sucralfate group) or the duration of the stay in the ICU (median, nine days in both groups).
Conclusions
Among critically ill patients requiring mechanical ventilation, those receiving ranitidine had a significantly lower rate of clinically important gastrointestinal bleeding than those treated with sucralfate. There were no significant differences in the rates of ventilator-associated pneumonia, the duration of the stay in the ICU, or mortality.
Media in This Article
Table 1
Base-Line Characteristics of the Study Patients.Table 2
Erosive or Ulcerative Conditions Affecting the Esophagus, Stomach, or Duodenum in the Two Study Groups.Article Activity
- Article
Prophylaxis against stress ulcers has traditionally been recommended for the prevention of upper gastrointestinal bleeding in critically ill patients.1-3 Recent natural-history studies have documented a very low incidence of bleeding,4 however, suggesting that universal prophylaxis may not be warranted.5-7 Respiratory failure and coagulopathy are the strongest risk factors for clinically important gastrointestinal bleeding.8-11
Randomized trials of prophylaxis against stress ulcers, as compared with no prophylaxis, indicate that histamine H2-receptor antagonists and antacids prevent clinically important gastrointestinal bleeding.12 Observational studies have suggested, however, that a higher gastric pH is associated with gastric microbial growth,13 tracheobronchial colonization,14 and nosocomial pneumonia.15 In randomized trials, the cytoprotective agent sucralfate, which does not alter the gastric pH, has been associated with a trend toward a lower incidence of ventilator-associated pneumonia, both as compared with histamine H2-receptor antagonists and antacids16 and as compared with H2-receptor antagonists alone.17-30
The need to evaluate patients at highest risk for both bleeding and pneumonia31 and the need to blind care givers and research personnel to the treatment assignments, in order to minimize inflated treatment effects,32 prompted us to evaluate the rates of clinically important gastrointestinal bleeding, ventilator-associated pneumonia, and mortality in a randomized trial of 1200 patients who required mechanical ventilation and who were assigned to receive either ranitidine or sucralfate.
Methods
Enrollment
From October 1992 to May 1996, we screened consecutive patients admitted to 16 participating intensive care units (ICUs) to identify adults who were projected to require mechanical ventilation for at least 48 hours. Criteria for exclusion were a diagnosis of gastrointestinal bleeding or pneumonia on admission, gastrectomy, a prognosis considered to be hopeless, previous randomization in this or another trial, or receipt of two or more previous doses of open-label prophylactic therapy. The protocol was approved by the institutional review boards of all the participating centers, and the patients or their proxies gave informed consent.
Randomization
Patients were randomly assigned to study groups in blocks of six, with stratification according to center, by means of a computer-generated random-number table prepared at the McMaster University Methods Center and managed by the ICU study pharmacist at each site who administered the coded drugs. All care givers and other research personnel were unaware of the randomization schedule and the block size.
Blinding
The patients, research nurses, and all ICU care givers were unaware of the treatment assignments for the duration of the study. Therefore, clinicians did not monitor gastric pH. The radiologists, outcome adjudicators, all investigators, and the study statistician were also blinded until all events had been adjudicated and the analyses completed.
Drug Preparation, Dispensing, and Administration
The bags of ranitidine (Zantac, Glaxo Wellcome; prepared by Baxter) and ranitidine placebo were identical in appearance. The sucralfate (Sulcrate, Hoechst Marion Roussel) and sucralfate placebo slurries were identical in color, taste, and consistency. From coded ranitidine bags and sucralfate bottles stored in each ICU pharmacy, study pharmacists dispensed either active ranitidine (50 mg every eight hours) and sucralfate placebo or active sucralfate (1 g every six hours) and ranitidine placebo.
Ranitidine was administered in intravenous bolus form, with the dose adjusted for renal failure as follows: standard dose, 50 mg every 8 hours; dose for patients with an estimated creatinine clearance rate of 25 to 50 ml per minute, 50 mg every 12 hours; dose for patients with an estimated creatinine clearance rate below 25 ml per minute, 50 mg every 24 hours; and dose for patients dependent on dialysis, 50 mg every 12 hours. Sucralfate suspension was given through a nasogastric tube or orally. We followed all patients until they died or were discharged from the ICU.
Demographic Characteristics of the Patients
We documented each patient's age, sex, admitting diagnosis, location before admission to the ICU, score on the Acute Physiology and Chronic Health Evaluation (APACHE II) scale (range of scores, 0 to 71, with higher scores indicating more severe illness),33 and multiple-organ-dysfunction (MOD) score (range, 0 to 24, with higher scores indicating more severe organ dysfunction).34
Gastrointestinal Bleeding
We monitored patients for signs of overt gastrointestinal hemorrhage, including hematemesis, nasogastric aspirate containing blood or coffee-grounds material, melena, or hematochezia. The decision to perform endoscopy was left to the discretion of the intensive care specialist. Two physicians from the study's bleeding-adjudication committee examined all relevant clinical and diagnostic documents related to possible bleeding episodes in duplicate and independently, using previously defined criteria.35 We defined clinically important bleeding as overt bleeding plus one of the following four features, in the absence of other causes: a spontaneous drop of 20 mm Hg or more in the systolic or diastolic blood pressure within 24 hours after upper gastrointestinal bleeding; an increase in the pulse rate of 20 beats per minute and a decrease in the systolic blood pressure of 10 mm Hg on the patient's assuming an upright position; a decrease in the hemoglobin concentration of at least 2 g per deciliter in 24 hours and the transfusion of 2 units of packed red cells within 24 hours after bleeding; or failure of the hemoglobin concentration (in grams per deciliter) to increase after transfusion by at least the number of units transfused minus 2 (i.e., if 4 units of packed cells were transfused, the bleeding would be considered clinically important if the hemoglobin concentration did not rise by at least 2 g per deciliter).
Ventilator-Associated Pneumonia
Attending intensivists at each center used a modified version of the criteria of the Centers for Disease Control and Prevention (CDC)36 to identify patients in whom pneumonia was suspected on clinical grounds. These criteria were a new radiographic infiltrate that had persisted for at least 48 hours (as interpreted by designated study radiologists blinded to the patients' treatment assignments) plus at least two of the following: a temperature above 38.5°C or below 35.0°C, a leukocyte count of more than 10,000 per cubic millimeter or less than 3000 per cubic millimeter, purulent sputum, or isolation of pathogenic bacteria from an endotracheal aspirate.
Patients in whom ventilator-associated pneumonia was suspected on clinical grounds underwent bronchoalveolar lavage or protected brush-catheter sampling by the study bronchoscopist.37,38 Two members of the pneumonia-adjudication committee examined all relevant clinical and diagnostic documents related to possible cases of pneumonia in duplicate and independently, classifying patients according to several different methods. One method used was the modified CDC criteria described above36; another was the Clinical Pulmonary Infection Score devised by Pugin et al. (range, 0 to 12, with pneumonia defined by a score of 7 or higher).39 In addition, adjudicators used the criteria of the Memphis Ventilator-Associated Pneumonia Consensus Conference for definite ventilator-associated pneumonia (if there was radiographic evidence of abscess and a positive needle aspirate, or if there was histologic proof of pneumonia at biopsy or autopsy) and probable ventilator-associated pneumonia (if bronchoalveolar lavage or protected brush-catheter sampling yielded positive quantitative or semiquantitative cultures, if there was a positive blood culture of an organism found within 48 hours of isolation in the sputum, if there was a positive pleural-fluid culture of an organism found within 48 hours of isolation in the sputum, or if histologic examination showed formation of an abscess or consolidation with polymorphonuclear-cell infiltration).40 To make a final decision as to whether each patient had ventilator-associated pneumonia, adjudicators made a summary judgment based on all available information; disagreement was resolved through discussion. We determined a priori that the adjudication committee's consensus rate of pneumonia would be used for the primary analysis and that other definitions would be used in the secondary analyses.
Statistical Analysis
Since ventilator-associated pneumonia has been considered an important potential adverse effect of gastric pH–altering prophylaxis against stress ulcers and because previous trials did not examine pneumonia as rigorously as gastrointestinal bleeding, we designed our trial to have the statistical power to detect a difference in the rates of pneumonia. On the basis of data published through 1991, when our study was designed, we anticipated a 25 percent incidence of pneumonia and identified a 25 percent reduction in the risk of pneumonia associated with sucralfate as being plausible and clinically important. This led to the calculation of a sample size of 1200 patients as necessary to give the study 75 percent power to detect such a difference, assuming a two-sided significance test at the 0.05 level. We analyzed all patients in the groups to which they were randomly assigned, according to the intention-to-treat principle. We compared means using Student's t-test and compared proportions using the chi-square test, with two-tailed P values.41 We used Fisher's exact test when the number of data points was small. For the length of the stay in the ICU, we report data as medians and interquartile ranges.
We conducted analyses both with and without adjustment for the following variables, treated categorically: age (<65 or >65 years), sex, location before admission to the ICU (emergency room, operating room, hospital ward, or other ICU), medical or surgical (elective or emergency) status, APACHE II score (<25 or >25), MOD score (<5 or >5), and medical center (of which there were 16).42
Results
Enrollment
Of 7986 patients admitted to ICUs, 6786 were excluded for the following reasons: mechanical ventilation was expected to be needed for less than 48 hours (3754 patients), the prognosis was considered hopeless (481), the patient had pneumonia (988) or gastrointestinal bleeding (432) at admission, gastrectomy had been performed (41), the patient had previously undergone randomization in this or another trial (565), two or more previous doses of open-label prophylaxis had been received (230), the patient had undergone mechanical ventilation in another ICU (38), the patient or proxy was unable or unwilling to give informed consent (184), an administrative error occurred (44), the physician declined to have the patient enrolled (14), or another reason (15). Excluded patients were a mean (±SD) of 60.8±15.3 years of age and had a mean APACHE II score of 21.4±7.9.
We randomly assigned 1200 patients to the sucralfate or ranitidine group. Demographic and base-line physiologic characteristics were similar in the two groups (Table 1Table 1
Base-Line Characteristics of the Study Patients.).Protocol Violations, Compliance, and Nonstudy Prophylaxis
No patient received active drug instead of the assigned placebo, or vice versa. Of the scheduled doses of ranitidine and sucralfate, 94.2 percent and 91.7 percent, respectively, were administered. Among patients who missed doses, the mean number of doses missed was 2.3 (median, 3; interquartile range, 2 to 3) for ranitidine and 2.9 (median, 4; interquartile range, 1 to 4) for sucralfate.
Fourteen patients in the ranitidine group (2.3 percent) and 16 in the sucralfate group (2.6 percent) received an additional drug as prophylaxis against stress ulcers outside of the study protocol (P = 0.74). Most patients received enteral nutrition (70.3 percent and 71.8 percent, respectively; P =0.55). Enteral feeding was started a median of three days (interquartile range, two to four) after admission to the ICU.
Gastrointestinal Bleeding
In the ranitidine group, 10 of 596 patients (1.7 percent) had clinically important gastrointestinal bleeding, as compared with 23 of 604 (3.8 percent) in the sucralfate group (relative risk, 0.44; 95 percent confidence interval, 0.21 to 0.92; P = 0.02); the absolute reduction in the risk of bleeding was 2.1 percent (95 percent confidence interval, 0.29 to 3.97). The results of the analysis in which we adjusted for other factors were similar (relative risk, 0.45; 95 percent confidence interval, 0.22 to 0.92; P = 0.03).
Seventeen patients underwent upper gastrointestinal endoscopy; additional diagnostic tests included laparotomy (in four), angiography (three), sigmoidoscopy (three), and red-cell scanning (one); two patients were examined at autopsy. One patient in the sucralfate group had bleeding from a gastroduodenal anastomosis, and another in the same group had bleeding from an aortic graft–enteric fistula. The source of bleeding was unclear for 8 patients in the ranitidine group and for 11 patients in the sucralfate group. Table 2Table 2
Erosive or Ulcerative Conditions Affecting the Esophagus, Stomach, or Duodenum in the Two Study Groups. lists the 14 patients who had bleeding from gastric, esophageal, or duodenal erosions or discrete ulcers along with their study group, indication of bleeding, and diagnostic tests or procedures (Table 2). Post hoc subgroup analysis of patients with documented esophageal, gastric, or duodenal ulcers or erosions generated results consistent with our main findings (relative risk of bleeding in the ranitidine group as compared with the sucralfate group, 0.41; 95 percent confidence interval, 0.13 to 1.29; P = 0.22).Ventilator-Associated Pneumonia
Among 596 patients receiving ranitidine, 114 (19.1 percent) had ventilator-associated pneumonia, as compared with 98 of 604 (16.2 percent) in the sucralfate group (relative risk, 1.18; 95 percent confidence interval, 0.92 to 1.51; P = 0.19); the absolute difference in risk was 2.9 percent (95 percent confidence interval, -1.4 to 7.2). Results of the adjusted analysis were similar (relative risk, 1.14; 95 percent confidence interval, 0.91 to 1.44; P = 0.26).
Table 3Table 3
Patients with Ventilator-Associated Pneumonia. presents the rates of pneumonia when different diagnostic criteria were used. As the definition of pneumonia became more strict, the overall rate decreased, although the difference between the two groups persisted. Table 4Table 4
Organisms Associated with Ventilator-Associated Pneumonia in the Study Patients. shows the organisms isolated from endotracheal aspirates from patients with pneumonia. There was no significant difference in the types of isolates between the groups.Duration of Patients' Stay in the ICU
All patients were included in the analysis. The median length of the ICU stay was 9 days (interquartile range, 5 to 15) in the ranitidine group and 9 days (interquartile range, 5 to 17) in the sucralfate group (P = 0.27). The duration of intubation was 7 days (interquartile range, 4 to 13) in the ranitidine group and 8 days (interquartile range, 4 to 15) in the sucralfate group (P = 0.25).
Mortality in the ICU
Mortality in the ICU was similar among patients receiving ranitidine (140 of 596 [23.5 percent]) and those receiving sucralfate (138 of 604 [22.8 percent]; relative risk, 1.03; 95 percent confidence interval, 0.84 to 1.26; P = 0.79).
Discussion
We found that patients receiving ranitidine had a significantly lower risk of gastrointestinal bleeding than patients receiving sucralfate (relative risk, 0.44; 95 percent confidence interval, 0.21 to 0.92). This finding appears to contrast with the results of a recent meta-analysis, which suggested that the drugs' effect on bleeding was equivalent (relative risk, 0.95;95 percent confidence interval, 0.17 to 5.36)12; however, the confidence limits around these two estimates overlap widely, and the difference could be attributable to chance. We found no significant difference in the incidence of pneumonia between patients receiving an H2-receptor antagonist and those receiving sucralfate (relative risk, 1.18; 95 percent confidence interval, 0.92 to 1.51), a finding that is consistent with pooled data from previous randomized trials (relative risk, 1.19; 95 percent confidence interval, 0.98 to 1.44).12
The strengths of our trial include the measures taken to conceal the patients' treatment assignments; the blinding of care givers, research personnel, and analysts; the high rates of compliance; the adjudication of outcomes according to rigorous criteria; and the examination of the relation between prophylaxis and the incidence of ventilator-associated pneumonia defined according to a variety of criteria, given the absence of a well-accepted reference standard. Our study was limited by uncertainty about the causes of gastrointestinal bleeding; even in patients whose condition was stable enough for them to undergo endoscopy or other diagnostic tests, a site of bleeding could not always be identified. The source of bleeding remained unknown for 19 of 33 patients. Moreover, although our sample was large, the confidence intervals around key estimates were wide.
Previous randomized trials indicate that H2-receptor antagonists substantially lower the incidence of overt and clinically important bleeding as compared with no prophylaxis.12 Our findings show that rates of bleeding are lower among patients given H2-receptor antagonists than among those given sucralfate. The incidence of bleeding in the sucralfate group in this trial (3.8 percent) approximates the 3.7 percent incidence observed among untreated patients receiving mechanical ventilation in our natural-history study.11 Previous trials comparing sucralfate with no prophylaxis have found a significantly lower rate of overt bleeding with sucralfate23,29,43,44; however, in the single trial from which data on clinically important bleeding events could easily be extracted,29 1 of 30 patients in the control group and 1 of 24 patients in the sucralfate group had clinically important bleeding. Given all this evidence, it is plausible that sucralfate has no effect on clinically important bleeding.
Although we found no significant difference in the rates of pneumonia between the two groups, the relative risk suggests a trend toward a lower rate of pneumonia among patients receiving sucralfate. It is possible that sucralfate appears to have a small protective effect against pneumonia because stress-ulcer prophylactic medications that increase the gastric pH themselves increase the incidence of pneumonia. This contention is supported by direct comparisons of trials of H2-receptor antagonists with no prophylaxis, which show a trend toward higher rates of pneumonia among the patients receiving H2-receptor antagonists (odds ratio, 1.25; 95 percent confidence interval, 0.78 to 2.00).12 Furthermore, the relative effects of sucralfate and no prophylaxis against stress ulcers on the incidence of pneumonia is unclear. Among the 226 patients enrolled in two randomized trials, there was a trend toward a higher incidence of pneumonia among those receiving sucralfate than among those given no prophylaxis (odds ratio, 2.11; 95 percent confidence interval, 0.82 to 5.44).23,44
Previous cost-effectiveness studies and practice guidelines have appropriately considered not only the base-line risk of bleeding and the effectiveness of prophylaxis against stress ulcers, but also the clinical and economic consequences of different preventive approaches.45-47 The direct and indirect costs of medicines for prophylaxis vary among health care organizations — a fact that highlights the need to appraise economic evaluations critically to determine their applicability to specific settings. The incremental number of days in the ICU attributable to clinically important upper gastrointestinal bleeding is estimated to be seven, and the attributable risk of mortality is about 12.5 percent.48 The trend toward a lower rate of nosocomial pneumonia among patients receiving sucralfate rather than H2-receptor antagonists12 has been considered in some policy documents about the prophylactic treatment of stress ulcers. The development of ventilator-associated pneumonia may lead to an additional 13 days in the ICU,49 although the effect of this type of pneumonia on mortality is less certain.49,50
The patients at highest risk for clinically important bleeding are those who require mechanical ventilation for more than 48 hours and those with coagulopathy.8-11 The estimated number of critically ill patients undergoing ventilation who would need to receive prophylaxis with ranitidine rather than sucralfate to prevent one clinically important upper gastrointestinal hemorrhage is approximately 48.
Supported by the Medical Research Council of Canada and Hoechst Marion Roussel. Drugs were supplied by Glaxo Wellcome, Baxter, and Hoechst Marion Roussel. Dr. Cook is a Career Scientist of the Ontario Ministry of Health.
We are indebted to the members of the Canadian Critical Care Trials Group for their help, particularly the research nurses who participated in this study, and to Drs. Thomas Todd, Thomas Noseworthy, Timothy Winton, and Michael Tryba for their support and advice.
Source Information
From McMaster University, Hamilton, Ont. (D.C., G.G., H.F., L.G., A.M.); the University of Toronto, Toronto (J.M.); the University of Western Ontario, London (D.L., F.R., A.K.); Dalhousie University, Halifax, N.S. (R.H.); Memorial University, St. John's, Newf. (S.P.); and Queen's University, Kingston, Ont. (G.W.) — all in Canada.
Address reprint requests to Dr. Cook at the Department of Medicine, St. Joseph's Hospital, 50 Charlton Ave., Hamilton, ON L8N 4A6, Canada.
Other study investigators are listed in the Appendix.
Other authors were Martin Tweeddale, M.D., University of British Columbia, Vancouver; Joe Pagliarello, M.D., University of Ottawa, Ottawa, Ont.; and Richard Johnston, M.D., University of Alberta, Edmonton.
Appendix
In addition to the authors, the study investigators and institutions were as follows: B. Plumstead and L. Frighetto, Vancouver General Hospital, Vancouver, B.C.; T. Noseworthy, E. Konopad, S. Bishop, M.L. Derko, and K. Horon, Royal Alexandra Hospital, Edmonton, Alta.; D. Stollery, M. Goers, and R. Jarman, Grey Nun's Hospital, Edmonton, Alta.; D. Roberts, T. Ostrusniuk, and J. Studney, Winnipeg Health Sciences Center, Winnipeg, Man.; T. Winton, D. Foster, D. Baptiste, M. Steinberg, and M. Lee, Toronto Hospital, General Division, Toronto; G. Darling, M. Culham, and V. Bobiwash, Wellesley Hospital, Toronto; M. Lefcoe (study radiologist), D. McCormack (study bronchoscopist), L. McCarthy, and C. Gawlik, London Health Sciences Center (Victoria Campus), London, Ont.; S. Langdon, M. Johnson, and C. Charters, London Health Sciences Center (University Campus), London, Ont.; M.K. Scott and S. Jansen, St. Joseph's Health Center, London, Ont.; E. McDonald, T. Dinh, and S. Toner, St. Joseph's Hospital, Hamilton, Ont.; S. Salama, Henderson Hospital, Hamilton, Ont.; A. Taite and P. Newman, Kingston General Hospital, Kingston, Ont.; M. Loewen, Ottawa Civic Hospital, Ottawa, Ont.; D. Gibbons, G. Leaman, and G. Gibbons, Health Sciences Center, St. John's, Newf.; P. Roy, M. Coffin, and H. Lummis, Victoria General Hospital, Halifax, N.S.; Methods Center — P. Austin and S. Troyan (project coordinators), L. Buckingham (data-base manager), and S. Duchesne (data entry); Adjudication Committees — D. Heyland, A. Freitag, K. Gough, M. Meade, A. Sarabia, M. Turner, H. Devitt, B. Guslits, M. Heule, R. Jaeschke, and J. Lang.
- References
References
1
Borrero E ,Bank S ,Margolis IB ,Schulman ND ,Chardavoyne R . Comparison of antacid and sucralfate in the prevention of gastrointestinal bleeding in patients who are critically ill. Am J Med 1985;79:Suppl 2C:62-64
CrossRef | Web of Science | Medline2
Noseworthy TW ,Shustack A ,Johnston RG ,Anderson BJ ,Konopad E ,Grace M . A randomized clinical trial comparing ranitidine and antacids in critically ill patients. Crit Care Med 1987;15:817-819
CrossRef | Web of Science | Medline3
Shuman RB ,Schuster DP ,Zuckerman GR . Prophylactic therapy for stress ulcer bleeding: a reappraisal. Ann Intern Med 1987;106:562-567
Web of Science | Medline4
Zandstra DF ,Stoutenbeek CP . The virtual absence of stress-ulceration related bleeding in ICU patients receiving prolonged mechanical ventilation without any prophylaxis: a prospective cohort study. Intensive Care Med 1994;20:335-340
CrossRef | Web of Science | Medline5
Schuster DP . Stress ulcer prophylaxis: in whom? With what? Crit Care Med 1993;21:4-6
CrossRef | Web of Science | Medline6
Tryba M . Stress ulcer prophylaxis -- quo vadis? Intensive Care Med 1994;20:311-313
CrossRef | Web of Science | Medline7
Navab F ,Steingrub J . Stress ulcer: is routine prophylaxis necessary? Am J Gastroenterol 1995;90:708-712
Web of Science | Medline8
Kamada T ,Fusamoto H ,Kawano S ,Noguchi M ,Hiramatsu K . Gastrointestinal bleeding following head injury: a clinical study of 433 cases. J Trauma 1977;17:44-47
CrossRef | Web of Science | Medline9
Schuster DP ,Rowley H ,Feinstein S ,McGue MK ,Zuckerman GR . Prospective evaluation of the risk of upper gastrointestinal bleeding after admission to a medical intensive care unit. Am J Med 1984;76:623-630
CrossRef | Web of Science | Medline10
LaCroix J ,Nadeau D ,Laberge S ,Gauthier M ,Lapierre G ,Farrell CA . Frequency of upper gastrointestinal bleeding in a pediatric intensive care unit. Crit Care Med 1992;20:35-42
CrossRef | Web of Science | Medline11
Cook DJ ,Fuller HD ,Guyatt GH , et al. Risk factors for gastrointestinal bleeding in critically ill patients. N Engl J Med 1994;330:377-381
Full Text | Web of Science | Medline12
Cook DJ ,Reeve BK ,Guyatt GH , et al. Stress ulcer prophylaxis in critically ill patients: resolving discordant meta-analyses. JAMA 1996;275:308-314
CrossRef | Web of Science | Medline13
Atherton ST ,White DJ . Stomach as source of bacteria colonising respiratory tract during artificial ventilation. Lancet 1978;2:968-969
CrossRef | Web of Science | Medline14
du Moulin GC ,Paterson DG ,Hedley-White J ,Lisbon A . Aspiration of gastric bacteria in antacid-treated patients: a frequent cause of postoperative colonisation of the airway. Lancet 1982;1:242-245
CrossRef | Web of Science | Medline15
Craven DE ,Kunches LM ,Kilinsky V ,Lichtenberg DA ,Make BJ ,McCabe WR . Risk factors for pneumonia and fatality in patients receiving continuous mechanical ventilation. Am Rev Respir Dis 1986;133:792-796
Web of Science | Medline16
Driks MR ,Craven DE ,Celli BR , et al. Nosocomial pneumonia in intubated patients given sucralfate as compared with antacids or histamine type 2 blockers: the role of gastric colonization. N Engl J Med 1987;317:1376-1382
Full Text | Web of Science | Medline17
Laggner AN ,Lenz K ,Graninger W , et al. Stressblutungprophylaxe auf einer internen Intensivstation: Sucralfat versus Ranitidin. Anaesthesist 1988;37:704-710
Web of Science | Medline18
Prodhom G, Leuenberger PH, Blum AL, et al. Effect of stress ulcer prophylaxis on nosocomial pneumonia in ventilated patients: a randomized comparative study. In: Program and abstracts of the 31st Interscience Conference on Antimicrobial Agents and Chemotherapy, Chicago, September 29–October 2, 1991. Washington, D.C.: American Society for Microbiology, 1991.
19
Pickworth KK ,Falcone RE ,Hoogeboom JE ,Santanello SA . Incidence of nosocomial pneumonia in mechanically ventilated trauma patients: a comparison of sucralfate and rantidine. Crit Care Med 1992;20:Suppl:S95-S95 abstract.20
Garcia-Labattut A ,Rodriquez-Munos S ,Gobernado-Serrano M , et al. Sucralfate versus cimetidine in the stress bleeding prophylaxis. Intensive Care Med 1990;16:Suppl 1:S19-S19 abstract.21
Eddleston JM ,Vohra A ,Scott P , et al. A comparison of the frequency of stress ulceration and secondary pneumonia in sucralfate or ranitidine-treated intensive care unit patients. Crit Care Med 1991;19:1491-1496
CrossRef | Web of Science | Medline22
Cannon LA ,Heiselman DE ,Gardner WG ,Jones J . Prophylaxis of upper gastrointestinal tract bleeding in mechanically ventilated patients: a randomized study comparing the efficacy of sucralfate, cimetidine, and antacids. Arch Intern Med 1987;147:2101-2106
CrossRef | Web of Science | Medline23
Ben-Menachem T ,Fogel R ,Patel RV , et al. Prophylaxis for stress-related gastric hemorrhage in the medical intensive care unit: a randomized, controlled, single-blind study. Ann Intern Med 1994;121:568-575
Web of Science | Medline24
Ryan P ,Dawson J ,Teres D ,Celoria G ,Navab F . Nosocomial pneumonia during stress ulcer prophylaxis with cimetidine and sucralfate. Arch Surg 1993;128:1353-1357
Web of Science | Medline25
Fabian TC ,Boucher BA ,Croce MA , et al. Pneumonia and stress ulceration in severely injured patients: a prospective evaluation of the effects of stress ulcer prophylaxis. Arch Surg 1993;128:185-191
Web of Science | Medline26
Levy MM ,Corson R ,Miyasaki A ,Tom R . Randomized trial: continuous infusion H2 blockers: bolus H2 blockers or carafate bid for the prophylaxis of stress ulcers in the ICU. Crit Care Med 1993;21:Suppl:S181-S181 abstract.
CrossRef27
Mustafa NA ,Akturk G ,Ozen I , et al. Acute stress bleeding prophylaxis with sucralfate versus ranitidine and increase of secondary pneumonia in intensive care unit patients. Intensive Care Med 1995;21:287-287 abstract.
CrossRef | Web of Science | Medline28
Thomason M ,Reeves R ,Payseur E ,Maddox A ,Hakenewerth A ,Norton J . Nosocomial pneumonia in ventilated trauma patients during stress ulcer prophylaxis with sucralfate, ranitidine and antacid. Crit Care Med 1995;23:Suppl:A93-A93 abstract.29
Ruiz-Santana S ,Ortiz E ,Gonzalez B ,Bolanos J ,Ruiz-Santana AJ ,Manzano JL . Stress-induced gastroduodenal lesions and total parenteral nutrition in critically ill patients: frequency, complications, and the value of prophylactic treatment: a prospective, randomized study. Crit Care Med 1991;19:887-891
CrossRef | Web of Science | Medline30
Simms HH ,DeMaria E ,McDonald L ,Peterson D ,Robinson A ,Burchard KW . Role of gastric colonization in the development of pneumonia in critically ill trauma patients: results of a prospective randomized trial. J Trauma 1991;31:531-536
CrossRef | Web of Science | Medline31
Peterson WL . Prevention of upper gastrointestinal bleeding. N Engl J Med 1994;330:428-429
Full Text | Web of Science | Medline32
Schulz KF ,Chalmers I ,Hayes RJ ,Altman D . Empirical evidence of bias: dimensions of methodological quality associated with estimates of treatment effects in controlled trials. JAMA 1995;273:408-412
CrossRef | Web of Science | Medline33
Knaus WA ,Draper EA ,Wagner DP ,Zimmerman JE . APACHE II: a severity of disease classification system. Crit Care Med 1985;13:818-829
CrossRef | Web of Science | Medline34
Marshall JC ,Cook DJ ,Christou NV ,Bernard GR ,Sprung CL ,Sibbald WJ . Multiple organ dysfunction score: a reliable descriptor of a complex clinical outcome. Crit Care Med 1995;23:1638-1652
CrossRef | Web of Science | Medline35
Cook DJ ,Pearl RG ,Cook RJ ,Guyatt GH . Incidence of clinically important bleeding in mechanically ventilated patients. J Intensive Care Med 1991;6:167-17436
CDC definitions for nosocomial infections, 1988Am Rev Respir Dis 1989;139:1058-1059
Web of Science | Medline37
Wimberley N ,Faling LJ ,Bartlett JG . A fiberoptic bronchoscopy technique to obtain uncontaminated lower airway secretions for bacterial culture. Am Rev Respir Dis 1979;119:337-343
Web of Science | Medline38
Meduri GU ,Chastre J . The standardization of bronchoscopic techniques for ventilator-associated pneumonia. Chest 1992;102:Suppl 1:557S-564S
CrossRef | Web of Science | Medline39
Pugin J ,Auckenthaler R ,Mili N ,Janssens JP ,Lew PD ,Suter PM . Diagnosis of ventilator-associated pneumonia by bacteriologic analysis of bronchoscopic and nonbronchoscopic “blind“ bronchoalveolar lavage fluid. Am Rev Respir Dis 1991;143:1121-1129
Web of Science | Medline40
Pingleton SK ,Fagon JY ,Leeper KV Jr . Patient selection for clinical investigation of ventilator-associated pneumonia: criteria for evaluating diagnostic techniques. Chest 1992;102:Suppl 1:553S-556S
CrossRef | Web of Science | Medline41
Fleiss JL. Statistical methods for rates and proportions. 2nd ed. New York: John Wiley, 1981.
42
Aitkin M, Anderson D, Francis B, Hinde J. Statistical modelling in GLIM. Oxford, England: Clarendon Press, 1989.
43
Labattut AG ,Santolalla PM ,De Andres AP ,Ortigosa AM , Del Mar Gobernado Serrano M,Gimeno OL . Efficacy of sucralfate in the prevention of upper gastrointestinal stress bleeding in intensive care patients: comparison vs a control group. Clin Intensive Care 1992;3:Suppl:S19-S2544
Eddleston JM ,Pearson RC ,Holland J ,Tooth JA ,Vohra A ,Doran BH . Prospective endoscopic study of stress erosions and ulcers in critically ill adult patients treated with either sucralfate or placebo. Crit Care Med 1994;22:1949-1954
CrossRef | Web of Science | Medline45
Schumock GT ,Lam NP ,Winkler SR ,Kong SX . Pharmacoeconomic analysis of stress ulcer prophylaxis for critically ill patients. Pharmacoeconomics 1996;9:455-465
CrossRef | Web of Science | Medline46
Ben-Menachem T ,McCarthy BD ,Fogel R , et al. Prophylaxis for stress-related gastrointestinal hemorrhage: a cost effectiveness analysis. Crit Care Med 1996;24:338-345
CrossRef | Web of Science | Medline47
Erstad BL ,Camamo JM ,Miller MJ ,Webber AM ,Fortune J . Impacting cost and appropriateness of stress ulcer prophylaxis at a university medical center. Crit Care Med 1997;25:1678-1684
CrossRef | Web of Science | Medline48
Heyland DK ,Gafni A ,Griffith L , et al. The clinical and economic consequence of clinically important gastrointestinal bleeding in critically ill patients. Clin Intensive Care 1996;7:121-125
CrossRef49
Fagon JY ,Chastre J ,Hance AJ ,Montravers P ,Novara A ,Gibert C . Nosocomial pneumonia in ventilated patients: a cohort study evaluating attributable mortality and hospital stay. Am J Med 1993;94:281-288
CrossRef | Web of Science | Medline50
Papazian L ,Bregeon F ,Thirion X , et al. Effect of ventilator-associated pneumonia on mortality and morbidity. Am J Respir Crit Care Med 1996;154:91-97
Web of Science | Medline
- Citing Articles (221)
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1
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CrossRef2
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CrossRef3
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CrossRef4
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CrossRef5
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CrossRef6
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CrossRef7
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CrossRef8
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CrossRef9
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CrossRef10
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CrossRef11
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CrossRef12
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CrossRef13
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CrossRef14
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CrossRef15
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CrossRef16
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CrossRef17
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CrossRef18
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CrossRef19
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CrossRef20
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CrossRef21
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CrossRef22
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CrossRef23
Luis D. Pacheco, Labib Ghulmiyyah. 2010. Ventilator Management in Critical Illness. , 124-151.
CrossRef24
Lee E. Morrow, Marin H. Kollef. (2010) Recognition and prevention of nosocomial pneumonia in the intensive care unit and infection control in mechanical ventilation. Critical Care Medicine 38, S352-S362
CrossRef25
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CrossRef26
F.H. Klebl. (2010) Gastrointestinale Blutungen bei Intensivpatienten. Intensivmedizin und Notfallmedizin 47:4, 260-265
CrossRef27
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CrossRef28
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CrossRef29
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CrossRef30
Pei-Chin Lin, Chia-Hsuin Chang, Ping-I Hsu, Pi-Lai Tseng, Yaw-Bin Huang. (2010) The efficacy and safety of proton pump inhibitors vs histamine-2 receptor antagonists for stress ulcer bleeding prophylaxis among critical care patients: A meta-analysis. Critical Care Medicine 38:4, 1197-1205
CrossRef31
Derek C. Angus, Jean-Paul Mira, Jean-Louis Vincent. (2010) Improving clinical trials in the critically ill. Critical Care Medicine 38:2, 527-532
CrossRef32
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CrossRef33
G. Offenstadt, E. Maury. 2010. Prévention des hémorragies gastroduodénales de stress. , 267-275.
CrossRef34
Cristina B. Terzi Coelho, Desanka Dragosavac, João S. Coelho Neto, Ciro G. Montes, Fábio Guerrazzi, Nelson Adami Andreollo. (2009) Ranitidine is unable to maintain gastric pH levels above 4 in septic patients. Journal of Critical Care 24:4, 627.e7-627.e13
CrossRef35
Emilio Bouza, Almudena Burillo. 2009. Nosocomial Pneumonia in Critical Care. , 178-207.
CrossRef36
Deborah J Cook, James Douketis, Donald Arnold, Mark A Crowther. (2009) Bleeding and venous thromboembolism in the critically ill with emphasis on patients with renal insufficiency. Current Opinion in Pulmonary Medicine 15:5, 455-462
CrossRef37
Alex Mejia, Walter K Kraft. (2009) Acid peptic diseases: pharmacological approach to treatment. Expert Review of Clinical Pharmacology 2:3, 295-314
CrossRef38
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CrossRef39
Alicia N. Kieninger, Pamela A. Lipsett. (2009) Hospital-Acquired Pneumonia: Pathophysiology, Diagnosis, and Treatment. Surgical Clinics of North America 89:2, 439-461
CrossRef40
Nimish Vakil. (2009) Acid Inhibition and Infections Outside the Gastrointestinal Tract. The American Journal of Gastroenterology 104, S17-S20
CrossRef41
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CrossRef42
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CrossRef43
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CrossRef44
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CrossRef45
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CrossRef46
S. MAGNASON, K. G. KRISTINSSON, T. STEFANSSON, H. ERLENDSDOTTIR, K. JONSDOTTIR, M. KRISTJANSSON, E. JONMUNDSSON, L. BALDURSDOTTIR, H. SIGVALDASON, S. GUDMUNDSSON. (2008) Risk factors and outcome in ICU-acquired infections. Acta Anaesthesiologica Scandinavica 52:9, 1238-1245
CrossRef47
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CrossRef48
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CrossRef49
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CrossRef50
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CrossRef51
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CrossRef52
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CrossRef53
A. M. E. Spoelstra - de Man, A. R. J. Girbes. (2008) Comment on “Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock: 2008” by Dellinger et al.. Intensive Care Medicine 34:6, 1160-1162
CrossRef54
R. G. Masterton, A. Galloway, G. French, M. Street, J. Armstrong, E. Brown, J. Cleverley, P. Dilworth, C. Fry, A. D. Gascoigne, A. Knox, D. Nathwani, R. Spencer, M. Wilcox. (2008) Guidelines for the management of hospital-acquired pneumonia in the UK: Report of the Working Party on Hospital-Acquired Pneumonia of the British Society for Antimicrobial Chemotherapy. Journal of Antimicrobial Chemotherapy 62:1, 5-34
CrossRef55
F.H. Klebl, J. Schölmerich. (2008) Future expectations in the prophylaxis of intestinal bleeding. Best Practice & Research Clinical Gastroenterology 22:2, 373-387
CrossRef56
David A. Edelman, Krupa R. Patel, James G. Tyburski, Lisa G. Hall Zimmerman. (2008) Intravenous pantoprazole utilization in a level 1 trauma center. Surgical Endoscopy 22:4, 967-973
CrossRef57
Leanne B. Gasink, Ebbing Lautenbach. (2008) Prevention and Treatment of Health Care–Acquired Infections. Medical Clinics of North America 92:2, 295-313
CrossRef58
Jürgen Graf, U. Janssens. (2008) Qualitätsmanagement in der Intensivmedizin. Intensivmedizin und Notfallmedizin 45:1, 1-11
CrossRef59
S.Y. Donati, L. Papazian. (2008) Polmoniti nosocomiali acquisite sotto ventilazione meccanica. EMC - Anestesia-Rianimazione 13:4, 1-16
CrossRef60
R. Phillip Dellinger, Mitchell M. Levy, Jean M. Carlet, Julian Bion, Margaret M. Parker, Roman Jaeschke, Konrad Reinhart, Derek C. Angus, Christian Brun-Buisson, Richard Beale, Thierry Calandra, Jean-Francois Dhainaut, Herwig Gerlach, Maurene Harvey, John J. Marini, John Marshall, Marco Ranieri, Graham Ramsay, Jonathan Sevransky, B. Taylor Thompson, Sean Townsend, Jeffrey S. Vender, Janice L. Zimmerman, Jean-Louis Vincent. (2008) Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock: 2008. Intensive Care Medicine 34:1, 17-60
CrossRef61
R Phillip Dellinger, Mitchell M. Levy, Jean M. Carlet, Julian Bion, Margaret M. Parker, Roman Jaeschke, Konrad Reinhart, Derek C. Angus, Christian Brun-Buisson, Richard Beale, Thierry Calandra, Jean-Francois Dhainaut, Herwig Gerlach, Maurene Harvey, John J. Marini, John Marshall, Marco Ranieri, Graham Ramsay, Jonathan Sevransky, B Taylor Thompson, Sean Townsend, Jeffrey S. Vender, Janice L. Zimmerman, Jean-Louis Vincent. (2008) Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock: 2008. Critical Care Medicine 36:1, 296-327
CrossRef62
Sean M Berenholtz, Aliaksei Pustavoitau, Steven J Schwartz, Peter J Pronovost. (2007) How safe is my intensive care unit? Methods for monitoring and measurement. Current Opinion in Critical Care 13:6, 703-708
CrossRef63
Alison M. Stevens, Zachariah Thomas. (2007) Critical Care Therapeutics - The Case Against Stress Ulcer Prophylaxis in 2007. Hospital Pharmacy 42:11, 995-999
CrossRef64
Frank H Klebl, Jürgen Schölmerich. (2007) Therapy Insight: prophylaxis of stress-induced gastrointestinal bleeding in critically ill patients. Nature Clinical Practice Gastroenterology & Hepatology 4:10, 562-570
CrossRef65
James S. Scolapio. (2007) Decreasing Aspiration Risk with Enteral Feeding. Gastrointestinal Endoscopy Clinics of North America 17:4, 711-716
CrossRef66
C. G. Mayhall. (2007) In Pursuit of Ventilator-Associated Pneumonia Prevention: The Right Path. Clinical Infectious Diseases 45:6, 712-714
CrossRef67
Sean M. Berenholtz, Peter J. Pronovost. (2007) Monitoring Patient Safety. Critical Care Clinics 23:3, 659-673
CrossRef68
A. P. Gratrix, S. M. Enright, H. A. O'Beirne. (2007) A survey of stress ulcer prophylaxis in Intensive Care Units in the UK. Anaesthesia 62:4, 421-422
CrossRef69
Peter J. Watkinson, Vicki S. Barber, Paul Dark, J. Duncan Young. (2007) The use of pre- pro- and synbiotics in adult intensive care unit patients: Systematic review. Clinical Nutrition 26:2, 182-192
CrossRef70
Jefferson M. Sesler. (2007) Stress-related Mucosal Disease in the Intensive Care Unit. AACN Advanced Critical Care 18:2, 119-126
CrossRef71
Francesca Rubulotta, Antonino Gullo, Fulvio Iscra. (2007) Recommendations for ulcer prophylaxis in the treatment of patients with severe sepsis and septic shock: a dog chasing its tail?. Intensive Care Medicine 33:4, 718-720
CrossRef72
L. FISHER, A. FISHER, P. PAVLI, M. DAVIS. (2007) Perioperative acute upper gastrointestinal haemorrhage in older patients with hip fracture: incidence, risk factors and prevention. Alimentary Pharmacology & Therapeutics 25:3, 297-308
CrossRef73
Loren Laine. (2007) Upper gastrointestinal bleeding. Clinical Update 14:3, 1-4
CrossRef74
David Sidebotham, Michael Gillham. 2007. Nutrition and Disorders of Gastrointestinal and Hepatic Function. , 495-509.
CrossRef75
Kristen C. Sihler, Avery B. Nathens. (2006) Management of Severe Sepsis in the Surgical Patient. Surgical Clinics of North America 86:6, 1457-1481
CrossRef76
Jason R. Leong, David T. Huang. (2006) Ventilator-Associated Pneumonia. Surgical Clinics of North America 86:6, 1409-1429
CrossRef77
Russell, James A., . (2006) Management of Sepsis. New England Journal of Medicine 355:16, 1699-1713
Full Text78
Ian Jenkins. (2006) Evidence-based sepsis therapy: A hospitalist perspective. Journal of Hospital Medicine 1:5, 285-295
CrossRef79
K. Reinhart, F. M. Brunkhorst, H.-G. Bone, H. Gerlach, M. Gründling, G. Kreymann, P. Kujath, G. Marggraf, K. Mayer, A. Meier-Hellmann, C. Peckelsen, C. Putensen, F. Stüber, M. Quintel, M. Ragaller, R. Rossaint, N. Weiler, T. Welte, K. Werdan. (2006) Diagnose und Therapie der Sepsis. Clinical Research in Cardiology 95:8, 429-454
CrossRef80
Jeremy M. Kahn, Jason N. Doctor, Gordon D. Rubenfeld. (2006) Stress ulcer prophylaxis in mechanically ventilated patients: integrating evidence and judgment using a decision analysis. Intensive Care Medicine 32:8, 1151-1158
CrossRef81
Christine S. Cocanour, Michelle Peninger, Bradley D. Domonoske, Tao Li, Bobbie Wright, Alicia Valdivia, Katharine M. Luther. (2006) Decreasing Ventilator-Associated Pneumonia in a Trauma ICU. The Journal of Trauma: Injury, Infection, and Critical Care 61:1, 122-130
CrossRef82
K. Reinhart, F. M. Brunkhorst, H.-G. Bone, H. Gerlach, M. Gründling, G. Kreymann, P. Kujath, G. Marggraf, K. Mayer, A. Meier-Hellmann, C. Peckelsen, C. Putensen, F. Stüber, M. Quintel, M. Ragaller, R. Rossaint, N. Weiler, T. Welte, K. Werdan. (2006) Diagnose und Therapie der Sepsis. Intensivmedizin und Notfallmedizin 43:5, 369-384
CrossRef83
Guillermo Gutierrez, Vivek Jain. (2006) Medical Issues in Patients With Cardiothoracic Surgery. Clinical Pulmonary Medicine 13:3, 178-187
CrossRef84
T. Sauerbruch. (2006) Erhöhtes Pneumonierisiko durch gastrale Säurereduktion. Der Internist 47:4, 441-442
CrossRef85
Richard F. Harty, Hari B. Ancha. (2006) Stress ulcer bleeding. Current Treatment Options in Gastroenterology 9:2, 157-166
CrossRef86
K. Reinhart, F. M. Brunkhorst, H. G. Bone, H. Gerlach, M. Gründling, G. Kreymann, P. Kujath, G. Marggraf, K. Mayer, A. Meier-Hellmann, C. Peckelsen, C. Putensen, M. Quintel, M. Ragaller, R. Rossaint, F. Stüber, N. Weiler, T. Welte, K. Werdan. (2006) Diagnose und Therapie der Sepsis. Der Internist 47:4, 356-373
CrossRef87
Scott A. Flanders, Harold R. Collard, Sanjay Saint. (2006) Nosocomial pneumonia: State of the science. American Journal of Infection Control 34:2, 84-93
CrossRef88
Suveer Singh, Timothy W. Evans. (2006) Organ dysfunction during sepsis. Intensive Care Medicine 32:3, 349-360
CrossRef89
John C. Marshall. (2006) Surgical Decision-Making: Integrating Evidence, Inference, and Experience. Surgical Clinics of North America 86:1, 201-215
CrossRef90
Mitsumasa Hata, Motomi Shiono, Hisakuni Sekino, Hidekazu Furukawa, Akira Sezai, Mitsuru Iida, Isamu Yoshitake, Tsutomu Hattori, Shinji Wakui, Makoto Taoka, Nanao Negishi, Yukiyasu Sezai. (2006) Efficacy of a Proton Pump Inhibitor Given in the Early Postoperative Period to Relieve Symptoms of Hiatal Hernia After Open Heart Surgery. Surgery Today 36:2, 131-134
CrossRef91
Jean-Louis Vincent, Fr??d??rique Jacobs. (2006) Initial Empirical Antibacterial Therapy of Ventilator-Associated Pneumonia. Treatments in Respiratory Medicine 5:2, 85-91
CrossRef92
Mohammed A. Qadeer, Joel E. Richter, Daniel J. Brotman. (2006) Hospital-acquired gastrointestinal bleeding outside the critical care unit: Risk factors, role of acid suppression, and endoscopy findings. Journal of Hospital Medicine 1:1, 13-20
CrossRef93
P. N. MATON. (2005) Review article: prevention of stress-related mucosal bleeding with proton-pump inhibitors. Alimentary Pharmacology and Therapeutics 22:s3, 45-52
CrossRef94
Jelica Kurtovic, Stephen M. Riordan, Roger Williams. (2005) Fulminant hepatic failure. Current Treatment Options in Gastroenterology 8:6, 503-518
CrossRef95
Traci L. Hedrick, Robert G. Sawyer. (2005) Health-Care–Associated Infections and Prevention. Surgical Clinics of North America 85:6, 1137-1152
CrossRef96
Robert Garcia. (2005) A review of the possible role of oral and dental colonization on the occurrence of health care-associated pneumonia: Underappreciated risk and a call for interventions. American Journal of Infection Control 33:9, 527-541
CrossRef97
Nasia Safdar, Cameron Dezfulian, Harold R. Collard, Sanjay Saint. (2005) Clinical and economic consequences of ventilator-associated pneumonia: A systematic review. Critical Care Medicine 33:10, 2184-2193
CrossRef98
David A Peura. (2005) Management of stress-related bleeding: evolution from the era before cimetidine. Nature Clinical Practice Gastroenterology & Hepatology 2:9, 388-389
CrossRef99
J. Mossner, K. Caca. (2005) Developments in the inhibition of gastric acid secretion. European Journal of Clinical Investigation 35:8, 469-475
CrossRef100
Michael Young. (2005) How would Consumer Reports rate care in the intensive care unit?*. Critical Care Medicine 33:8, 1860-1862
CrossRef101
Eric Maury, Jacques Tankovic, Anne Ebel, Georges Offenstadt. (2005) An observational study of upper gastrointestinal bleeding in intensive care units: Is Helicobacter pylori the culprit?*. Critical Care Medicine 33:7, 1513-1518
CrossRef102
Megan Robertson. (2005) Helicobacter pylori and stress ulceration: An ongoing puzzle*. Critical Care Medicine 33:7, 1650-1652
CrossRef103
Jean-Louis Vincent. (2005) Give your patient a fast hug (at least) once a day*. Critical Care Medicine 33:6, 1225-1229
CrossRef104
Julie Polson, William M. Lee. (2005) AASLD position paper: The management of acute liver failure. Hepatology 41:5, 1179-1197
CrossRef105
Steven A. Conrad, Andrea Gabrielli, Benjamin Margolis, Andrew Quartin, J Steven Hata, William O. Frank, Robert G. Bagin, James A. Rock, Bonnie Hepburn, Loren Laine. (2005) Randomized, double-blind comparison of immediate-release omeprazole oral suspension versus intravenous cimetidine for the prevention of upper gastrointestinal bleeding in critically ill patients. Critical Care Medicine 33:4, 760-765
CrossRef106
K. H. Staubach. (2005) Pilzsepsis - Therapeutische Strategie. Fungal sepsis - therapeutical strategy. Mycoses 48:s1, 72-77
CrossRef107
James C. Hurley. (2005) Inapparent Outbreaks of Ventilator‐Associated Pneumonia: An Ecologic Analysis of Prevention and Cohort Studies • . Infection Control and Hospital Epidemiology 26:4, 374-390
CrossRef108
Neil Stollman, David C. Metz. (2005) Pathophysiology and prophylaxis of stress ulcer in intensive care unit patients. Journal of Critical Care 20:1, 35-45
CrossRef109
David A. Zygun, Kevin B. Laupland, Gordon H. Fick, James Dean Sandham, Christopher J. Doig. (2005) Neuroanesthesia and Intensive Care Limited ability of SOFA and MOD scores to discriminate outcome: a prospective evaluation in 1,436 patients. Canadian Journal of Anesthesia/Journal canadien d'anesthésie 52:3, 302-308
CrossRef110
Stephen B. Osmon, Marin H. Kollef. (2005) Prevention of Pneumonia in the Hospital Setting. Clinics in Chest Medicine 26:1, 135-142
CrossRef111
Christine S. Cocanour, Luis Ostrosky-Zeichner, Michelle Peninger, Debbi Garbade, Tommy Tidemann, Bradley D. Domonoske, Tao Li, Steven J. Allen, Katharine M. Luther. (2005) Cost of a Ventilator-Associated Pneumonia in a Shock Trauma Intensive Care Unit. Surgical Infections 6:1, 65-72
CrossRef112
Dean D. Bell, Peter G. Brindley, David Forrest, Osama Al Muslim, David Zygun. (2005) Management following resuscitation from cardiac arrest: Recommendations from the 2003 Rocky mountain critical care conference. Canadian Journal of Anesthesia/Journal canadien d'anesthésie 52:3, 309-322
CrossRef113
Gilles L. Fraser, Richard R. Riker. (2005) Caution and Patient Safety Concerns Should Guide Us. Critical Care Medicine 33:2, 471-472
CrossRef114
Jill A. Rebuck, Ryan J. Daley, Lynda S. Welage. (2005) Caution and Patient Safety Concerns Should Guide Us. Critical Care Medicine 33:2, 472
CrossRef115
Stuart J Spechler. (2005) Risk of community-acquired pneumonia after acid-suppressive drugs. Nature Clinical Practice Gastroenterology & Hepatology 2:2, 72-73
CrossRef116
Tom C. Martinsen, Kare Bergh, Helge L. Waldum. (2005) Gastric Juice: A Barrier Against Infectious Diseases. Basic <html_ent glyph="@amp;" ascii="&"/> Clinical Pharmacology <html_ent glyph="@amp;" ascii="&"/> Toxicology 96:2, 94-102
CrossRef117
David C. Metz. (2005) Preventing the gastrointestinal consequences of stress-related mucosal disease. Current Medical Research and Opinion 21:1, 11-18
CrossRef118
Mitsumasa Hata, Motomi Shiono, Hisakuni Sekino, Hidekazu Furukawa, Akira Sezai, Mitsuru Iida, Isamu Yoshitake, Tsutomu Hattori, Sinji Wakui, Masao Soeda, Makoto Taoka, Nanao Negishi, Yukiyasu Sezai. (2005) Prospective Randomized Trial for Optimal Prophylactic Treatment of the Upper Gastrointestinal Complications After Open Heart Surgery. Circulation Journal 69:3, 331-334
CrossRef119
Andrew F. Shorr, John H. Sherner, William L. Jackson, Marin H. Kollef. (2005) Invasive approaches to the diagnosis of ventilator-associated pneumonia: A meta-analysis. Critical Care Medicine 33:1, 46-53
CrossRef120
Thibaud d???Escrivan, Benoit Guery. (2005) Prevention and Treatment of Aspiration Pneumonia in Intensive Care Units. Treatments in Respiratory Medicine 4:5, 317-324
CrossRef121
Mitchell M. Levy, Peter J. Pronovost, R Phillip Dellinger, Sean Townsend, Roger K. Resar, Terry P. Clemmer, Graham Ramsay. (2004) Sepsis change bundles: Converting guidelines into meaningful change in behavior and clinical outcome. Critical Care Medicine 32:Supplement, S595-S597
CrossRef122
Stephen Trzeciak, R Phillip Dellinger. (2004) Other supportive therapies in sepsis: An evidence-based review. Critical Care Medicine 32:Supplement, S571-S577
CrossRef123
Ryan J. Daley, Jill A. Rebuck, Lynda S. Welage, Frederick B. Rogers. (2004) Prevention of stress ulceration: Current trends in critical care. Critical Care Medicine 32:10, 2008-2013
CrossRef124
Jean-Louis Vincent, Marialuisa Chierego, Marc Struelens, Baudouin Byl. (2004) Infection control in the intensive care unit. Expert Review of Anti-infective Therapy 2:5, 795-805
CrossRef125
R. Phillip Dellinger, Herwig Gerlach, Jean Carlet. (2004) Reply to Zandstra and van der Voort. Intensive Care Medicine 30:10, 1981-1981
CrossRef126
R Phillip Dellinger, Herwig Gerlach, Jean Carlet. (2004) A More Appropriate Critical Appraisal of the Available Evidence?. Critical Care Medicine 32:10, 2167
CrossRef127
J.-L Vincent. (2004) Ventilator-associated pneumonia. Journal of Hospital Infection 57:4, 272-280
CrossRef128
Dale M. Needham, Susan E. Bronskill, William J. Sibbald, Peter J. Pronovost, Andreas Laupacis. (2004) Mechanical ventilation in Ontario, 1992–2000: Incidence, survival, and hospital bed utilization of noncardiac surgery adult patients*. Critical Care Medicine 32:7, 1504-1509
CrossRef129
Marin H. Kollef. (2004) Prevention of hospital-associated pneumonia and ventilator-associated pneumonia. Critical Care Medicine 32:6, 1396-1405
CrossRef130
Marc J. M. Bonten, Marin H. Kollef, Jesse B. Hall. (2004) Risk Factors for Ventilator‐Associated Pneumonia: From Epidemiology to Patient Management. Clinical Infectious Diseases 38:8, 1141-1149
CrossRef131
Gordon S. Doig. (2004) Obesity-related excess mortality: What should we do now? *. Critical Care Medicine 32:4, 1084-1085
CrossRef132
R. Phillip Dellinger, Jean M. Carlet, Henry Masur, Herwig Gerlach, Thierry Calandra, Jonathan Cohen, Juan Gea-Banacloche, Didier Keh, John C. Marshall, Margaret M. Parker, Graham Ramsay, Janice L. Zimmerman, Jean-Louis Vincent, Mitchell M. Levy. (2004) Surviving Sepsis Campaign guidelines for management of severe sepsis and septic shock. Critical Care Medicine 32:3, 858-873
CrossRef133
Andrew F. Shorr, Mei-Sheng Duh, Kathleen M. Kelly, Marin H. Kollef. (2004) Red blood cell transfusion and ventilator-associated pneumonia: A potential link?. Critical Care Medicine 32:3, 666-674
CrossRef134
Mitchell J. Spirt. (2004) Stress-related mucosal disease: Risk factors and prophylactic therapy. Clinical Therapeutics 26:2, 197-213
CrossRef135
Christopher J. Doig, David A. Zygun, Gordon H. Fick, Kevin B. Laupland, Paul J. E. Boiteau, Reza Shahpori, Tom Rosenal, J. Dean Sandham. (2004) Study of clinical course of organ dysfunction in intensive care. Critical Care Medicine 32:2, 384-390
CrossRef136
Christianne A. van Nieuwenhoven, Erik Buskens, Dennis C. Bergmans, Frank H. van Tiel, Graham Ramsay, Marc J. M. Bonten. (2004) Oral decontamination is cost-saving in the prevention of ventilator-associated pneumonia in intensive care units. Critical Care Medicine 32:1, 126-130
CrossRef137
Marc J.M. Bonten. (2003) Prevention of hospital-acquired pneumonia:. Infectious Disease Clinics of North America 17:4, 773-784
CrossRef138
William R. Garnett. (2003) History of Acid Suppression: Focus on the Hospital Setting. Pharmacotherapy 23:10 Part 2, 56S-60S
CrossRef139
Brian L. Erstad. (2003) The Cost of Enhanced Acid Suppression. Pharmacotherapy 23:10 Part 2, 94S-100S
CrossRef140
Peter J. Pronovost, Sean M. Berenholtz, Koni Ngo, Marcy McDowell, Christine Holzmueller, Carol Haraden, Roger Resar, Tom Rainey, Tom Nolan, Todd Dorman. (2003) Developing and pilot testing quality indicators in the intensive care unit. Journal of Critical Care 18:3, 145-155
CrossRef141
Thomas A Russo, Bruce A Davidson, Ulrike B Carlino-MacDonald, Jadwiga D Helinski, Roger L Priore, Paul R Knight. (2003) The effects of Escherichia coli capsule, O-antigen, host neutrophils, and complement in a rat model of Gram-negative pneumonia. FEMS Microbiology Letters 226:2, 355-361
CrossRef142
Sean Berenholtz, Peter J. Pronovost. (2003) Barriers to translating evidence into practice. Current Opinion in Critical Care 9:4, 321-325
CrossRef143
Robert D. Stevens, Anish Bhardwaj, Jeffrey R. Kirsch, Marek A. Mirski. (2003) Critical Care and Perioperative Management in Traumatic Spinal Cord Injury. Journal of Neurosurgical Anesthesiology 15:3, 215-229
CrossRef144
J Hiramoto. (2003) Evidence-based analysis: postoperative gastric bleeding: etiology and prevention. Surgical Oncology 12:1, 9-19
CrossRef145
Donald R Duerksen. (2003) Stress-related mucosal disease in critically ill patients. Best Practice & Research Clinical Gastroenterology 17:3, 327-344
CrossRef146
Mitchell J. Spirt. (2003) Stress-related mucosal disease. Current Treatment Options in Gastroenterology 6:2, 135-145
CrossRef147
Gordon D. Rubenfeld. (2003) Epidemiology of acute lung injury. Critical Care Medicine 31:Supplement, S276-S284
CrossRef148
Pinak S. Acharya, David A. Lipson. (2003) Gastrointestinal Complications of Acute Respiratory Failure. Clinical Pulmonary Medicine 10:2, 80-84
CrossRef149
Neill Adhikari, William Sibbald. (2003) The Large Cost of Critical Care: Realities and Challenges. Anesthesia & Analgesia 96:2, 311-314
CrossRef150
Philippe Vander Linden. (2002) Anemia in Critically Ill Patients: How Much Can They Tolerate?. Transfusion Alternatives in Transfusion Medicine 4:4, 121-128
CrossRef151
Ramón Conejero, Alfonso Bonet, Teodoro Grau, Angel Esteban, Alfonso Mesejo, Juan Carlos Montejo, Jorge López, José Antonio Acosta. (2002) Effect of a glutamine-enriched enteral diet on intestinal permeability and infectious morbidity at 28 days in critically ill patients with Systemic Inflammatory Response Syndrome. Nutrition 18:9, 716-721
CrossRef152
Robert Kimura. (2002) Can the use of exogenous acids prevent infection in patients treated with inhibitors of gastric acid secretion to prevent stress ulcers?*. Critical Care Medicine 30:8, 1912-1913
CrossRef153
Deborah Cook, Roy Brower, Jamie Cooper, Laurent Brochard, Jean-Louis Vincent. (2002) Multicenter clinical research in adult critical care. Critical Care Medicine 30:7, 1636-1643
CrossRef154
George Nakos, Vasiliki D. Malamou-Mitsi, Alexandra Lachana, Aikaterini Karassavoglou, Eirini Kitsiouli, Niki Agnandi, Marilena E. Lekka. (2002) Immunoparalysis in patients with severe trauma and the effect of inhaled interferon-γ*. Critical Care Medicine 30:7, 1488-1494
CrossRef155
M. Brian Fennerty. (2002) Pathophysiology of the upper gastrointestinal tract in the critically ill patient: Rationale for the therapeutic benefits of acid suppression. Critical Care Medicine 30:Supplement, S351-S355
CrossRef156
Edward Abraham. (2002) Acid suppression in a critical care environment: State of the art and beyond. Critical Care Medicine 30:Supplement, S349-S350
CrossRef157
Joseph R. Pisegna. (2002) Pharmacology of acid suppression in the hospital setting: Focus on proton pump inhibition. Critical Care Medicine 30:Supplement, S356-S361
CrossRef158
Brooks D. Cash. (2002) Evidence-based medicine as it applies to acid suppression in the hospitalized patient. Critical Care Medicine 30:Supplement, S373-S378
CrossRef159
Kenneth P. Steinberg. (2002) Stress-related mucosal disease in the critically ill patient: Risk factors and strategies to prevent stress-related bleeding in the intensive care unit. Critical Care Medicine 30:Supplement, S362-S364
CrossRef160
Rumina Hasan, Sardar Ijlal Babar. (2002) Nosocomial and ventilator-associated pneumonias: developing country perspective. Current Opinion in Pulmonary Medicine 8:3, 188-194
CrossRef161
Alexandra Heininger, Wolfgang A. Krueger, Gerd Doring, Klaus Unertl. (2002) Ventilator-associated pneumonia. Current Opinion in Anaesthesiology 15:2, 153-159
CrossRef162
Sean M. Berenholtz, Todd Dorman, Koni Ngo, Peter J. Pronovost. (2002) Qualitative review of intensive care unit quality indicators. Journal of Critical Care 17:1, 1-12
CrossRef163
S KEENAN, D HEYLAND, M JACKA, D COOK, P DODEK. (2002) Ventilator-associated pneumonia: Prevention, diagnosis, and therapy. Critical Care Clinics 18:1, 107-125
CrossRef164
Jamie Gregor. (2001) Helicobacter pylori suppression: One more reason to consider selective gut decontamination?. Journal of Critical Care 16:4, 188
CrossRef165
Peter H.J. van der Voort, René W.M. van der Hulst, Durk F. Zandstra, Alfons A.M. Geraedts, Arie van der Ende, Guido N.J. Tytgat. (2001) Suppression of Helicobacter pylori infection during intensive care stay: Related to stress ulcer bleeding incidence?. Journal of Critical Care 16:4, 182-187
CrossRef166
D Stancic-Rokotov. (2001) Lung lesions and anti-ulcer agents beneficial effect: Anti-ulcer agents pentadecapeptide BPC 157, ranitidine, omeprazole and atropine ameliorate lung lesion in rats. Journal of Physiology-Paris 95:1-6, 303-308
CrossRef167
D Stancic-Rokotov. (2001) Ethanol gastric lesion aggravated by lung injury in rat. Therapy effect of antiulcer agents. Journal of Physiology-Paris 95:1-6, 289-293
CrossRef168
M. Koeman, A.J.A.M. van der Ven, G. Ramsay, I.M. Hoepelman, M.J.M. Bonten. (2001) Ventilator-associated pneumonia: recent issues on pathogenesis, prevention and diagnosis. Journal of Hospital Infection 49:3, 155-162
CrossRef169
Catherine A. Fleming, Henri U. Balaguera, Donald E. Craven. (2001) RISK FACTORS FOR NOSOCOMIAL PNEUMONIA. Medical Clinics of North America 85:6, 1545-1563
CrossRef170
Salmaan Kanji, John W. Devlin, Krista A. Piekos, Eric Racine. (2001) Recombinant Human Activated Protein C, Drotrecogin Alfa (activated): A Novel Therapy for Severe Sepsis. Pharmacotherapy 21:11, 1389-1402
CrossRef171
Deh-Ming Chang. (2001) Component multiple organ dysfunction score: Are we any closer to an ideal system?. Critical Care Medicine 29:11, 2223-2224
CrossRef172
Pierre-François Laterre, Yves Horsmans. (2001) Intravenous omeprazole in critically ill patients: A randomized, crossover study comparing 40 with 80 mg plus 8 mg/hour on intragastric pH. Critical Care Medicine 29:10, 1931-1935
CrossRef173
Peter J. Pronovost, Marlene R. Miller, Todd Dorman, Sean M. Berenholtz, Haya Rubin. (2001) Developing and implementing measures of quality of care in the intensive care unit. Current Opinion in Critical Care 7:4, 297-303
CrossRef174
Neil Soni. (2001) Lessons from Meta-analysis: The Case of Albumin. Transfusion Alternatives in Transfusion Medicine 3:4, 6-13
CrossRef175
Ricard Ferrer, Teresa Pont, Francisco Jos?? de Latorre. (2001) Airway Colonization in Intubated Patients. Clinical Pulmonary Medicine 8:4, 207-213
CrossRef176
Kentigern Thorburn, Mahil Samuel, Elisabeth Anne Smith, Paul Baines. (2001) Aluminum accumulation in critically ill children on sucralfate therapy. Pediatric Critical Care Medicine 2:3, 247-249
CrossRef177
Michael Tryba. (2001) Role of acid suppressants in intensive care medicine. Best Practice & Research Clinical Gastroenterology 15:3, 447-461
CrossRef178
Joseph R. Lentino. (2001) Nosocomial pneumonia: More than just ventilator-associated. Current Infectious Disease Reports 3:3, 266-273
CrossRef179
Wahid Wassef, Jorge Obando, Ashish Sharma. (2001) Upper Gastrointestinal Bleeding of Nonvariceal Origin in the ICU Setting. Journal of Intensive Care Medicine 16:3, 105-113
CrossRef180
Robert M. Rodriguez, Howard L. Corwin, Andrew Gettinger, Michael J. Corwin, Dean Gubler, Ronald G. Pearl. (2001) Nutritional deficiencies and blunted erythropoietin response as causes of the Amemia of critical illness. Journal of Critical Care 16:1, 36-41
CrossRef181
Sunil G. Sheth, J. Thomas LaMont. (2001) Gastrointetinal Problems in the Chronically Critically Ill Patient. Clinics in Chest Medicine 22:1, 135-147
CrossRef182
Hussain Mulla, Giles Peek, David Upton, Edward Lin, Mahmoud Loubani. (2001) Plasma aluminum levels during sucralfate prophylaxis for stress ulceration in critically ill patients on continuous venovenous hemofiltration: A randomized, controlled trial. Critical Care Medicine 29:2, 267-271
CrossRef183
R Dhôte, B Detournay, A Slama, L Hamel, M.A Bigard, P.E Bollaert, R Colin, J.Y Fagon, J.R Le Gall, J.C Raphaël. (2000) Enquête nationale sur les pratiques de prophylaxie des hémorragies gastroduodénales en réanimation. Réanimation Urgences 9:7, 550-554
CrossRef184
B Raynard, B Bernard, G Bleichner, J.Y Fagon. (2000) Prévention des hémorragies digestives hautes de stress en réanimation Révision de la conférence de consensus de 1988. Réanimation Urgences 9:7, 555-560
CrossRef185
Hartmut Lode, Manfred Raffenberg, Reiner Erbes, Hilte Geerdes-Fenge, Harald Mauch. (2000) Nosocomial pneumonia: epidemiology, pathogenesis, diagnosis, treatment and prevention. Current Opinion in Infectious Diseases 13:4, 377-384
CrossRef186
Peter H.J. van der Voort, Durk F. Zandstra. (2000) Pathogenesis, risk factors, and incidence of upper gastrointestinal bleeding after cardiac surgery: Is specific prophylaxis in routine bypass procedures needed?. Journal of Cardiothoracic and Vascular Anesthesia 14:3, 293-299
CrossRef187
Jean-Louis Vincent. (2000) Which therapeutic interventions in critical care medicine have been shown to reduce mortality in prospective, randomized, clinical trials? A survey of candidates for the Belgian Board Examination in Intensive Care Medicine. Critical Care Medicine 28:5, 1616-1620
CrossRef188
P. Malfertheiner, U. Peitz. (2000) Duodenal ulcer. Current Treatment Options in Gastroenterology 3:2, 171-181
CrossRef189
Ruth Hurley, Miriam V. Chapman, Michael G. Mythen. (2000) Current status of gastrointestinal tonometry. Current Opinion in Critical Care 6:2, 130-135
CrossRef190
H KF van Saene, M A de la Cal, A J Petros. (2000) To Suction or Not to Suction, Above the Cuff. Critical Care Medicine 28:2, 596-597
CrossRef191
David H Livingston. (2000) Prevention of ventilator-associated pneumonia. The American Journal of Surgery 179:2, 12-17
CrossRef192
Paul G. Jodka, Stephen O. Heard. (2000) Management of the Septic Patient in the Operating Room. International Anesthesiology Clinics 38:4, 1-29
CrossRef193
Daniel P. Schuster. (1999) Wringing blood from a turnip. Critical Care Medicine 27:12, 2846-2847
CrossRef194
Mitra B Drakulovic, Antoni Torres, Torsten T Bauer, Jose M Nicolas, Santiago Nogué, Miquel Ferrer. (1999) Supine body position as a risk factor for nosocomial pneumonia in mechanically ventilated patients: a randomised trial. The Lancet 354:9193, 1851-1858
CrossRef195
J.A. Louw, I.N. Marks. (1999) The treatment of peptic ulcer disease. Current Opinion in Gastroenterology 15:6, 497
CrossRef196
Daren K. Heyland, Deborah J. Cook, Phillip S. Schoenfeld, Andreas Frietag, Joseph Varon, Gordon Wood. (1999) The effect of acidified enteral feeds on gastric colonization in critically ill patients: Results of a multicenter randomized trial. Critical Care Medicine 27:11, 2399-2406
CrossRef197
Deborah Cook. (1999) Ventilator-associated pneumonia. Current Opinion in Critical Care 5:5, 350-356
CrossRef198
A. Brent Carter, Douglas B. Hornick. (1999) THERAPY FOR VENTILATOR-ASSOCIATED PNEUMONIA. Clinics in Chest Medicine 20:3, 681-691
CrossRef199
Marin H. Kollef. (1999) EPIDEMIOLOGY AND RISK FACTORS FOR NOSOCOMIAL PNUEMONIA. Clinics in Chest Medicine 20:3, 653-670
CrossRef200
John C. Marshall. (1999) Gastrointestinal flora and its alterations in critical illness. Current Opinion in Clinical Nutrition and Metabolic Care 2:5, 405-411
CrossRef201
Carol M. Mason, Steve Nelson. (1999) PULMONARY HOST DEFENSES. Clinics in Chest Medicine 20:3, 475-488
CrossRef202
Duncan LA Wyncoll, Timothy W Evans. (1999) Acute respiratory distress syndrome. The Lancet 354:9177, 497-501
CrossRef203
Tamir Ben-Menachem, Robert S. Bresalier. (1999) Prophylaxis for stress-related gastrointestinal hemorrhage. Current Treatment Options in Gastroenterology 2:4, 313-319
CrossRef204
Grant E. O???Keefe, Ronald V. Maier. (1999) Are we winning the battle in the surgical intensive care unit?. Current Opinion in Critical Care 5:4, 308
CrossRef205
M.J.M Bonten. (1999) Controversies on diagnosis and prevention of ventilator-associated pneumonia. Diagnostic Microbiology and Infectious Disease 34:3, 199-204
CrossRef206
Antoni Torres, Mustafa El-Ebiary, Ana Rañó. (1999) RESPIRATORY INFECTIOUS COMPLICATIONS IN THE INTENSIVE CARE UNIT. Clinics in Chest Medicine 20:2, 287-301
CrossRef207
Antonios Liolios, John M. Oropello, Ernest Benjamin. (1999) GASTROINTESTINAL COMPLICATIONS IN THE INTENSIVE CARE UNIT. Clinics in Chest Medicine 20:2, 329-345
CrossRef208
John B. Kortbeek, Philip I. Haigh, Christopher Doig. (1999) Duodenal Versus Gastric Feeding in Ventilated Blunt Trauma Patients. The Journal of Trauma: Injury, Infection, and Critical Care 46:6, 992-998
CrossRef209
John W. Devlin, Karen S. Claire, Scott A. Dulchavsky, James G. Tyburski. (1999) Impact of Trauma Stress Ulcer Prophylaxis Guidelines on Drug Cost and Frequency of Major Gastrointestinal Bleeding. Pharmacotherapy 19:4, 452-460
CrossRef210
Daren K. Heyland. (1999) Review of gut-specific strategies to reduce intensive care unit-acquired infections. Current Opinion in Critical Care 5:2, 132
CrossRef211
John C. Marshall. (1999) Gastrointestinal flora and its alterations in critical illness. Current Opinion in Critical Care 5:2, 119
CrossRef212
Kelly D. Flemming, Robert D. Brown, David O. Wiebers. (1999) Subarachnoid hemorrhage. Current Treatment Options in Neurology 1:2, 97-112
CrossRef213
Kollef, Marin H., . (1999) The Prevention of Ventilator-Associated Pneumonia. New England Journal of Medicine 340:8, 627-634
Full Text214
Grant W. Waterer, Richard G. Wunderink. (1999) Pulmonary infections. Current Opinion in Critical Care 5:1, 67
CrossRef215
Catherine M. Crill, Emily B. Hak. (1999) Upper Gastrointestinal Tract Bleeding in Critically Ill Pediatric Patients. Pharmacotherapy 19:2, 162-180
CrossRef216
Paul E Marik. (1999) Stress Ulcer Prophylaxis: A Practical Approach. Journal of Intensive Care Medicine 14:1, 1-8
CrossRef217
Michael Tryba. (1999) Research on stress ulcer prophylaxis. Critical Care Medicine 27:1, 16-17
CrossRef218
Deborah Cook, Stephen Walter, Andreas Freitag, Gordon Guyatt, Hugh Devitt, Maureen Meade, Lauren Griffith, Alicia Sarabia, Hugh Fuller, Mark Turner, Kevin Gough. (1998) Adjudicating ventilator-associated pneumonia in a randomized trial of critically ill patients. Journal of Critical Care 13:4, 159-163
CrossRef219
Imogen Mitchell, David Bihari. (1998) Glutamine-enriched enteral nutrition in patients with multiple trauma. The Lancet 352:9139, 1553
CrossRef220
Ernst W Hanisch, Albrecht Encke, Frank Naujoks, Joachim Windolf. (1998) A randomized, double-blind trial for stress ulcer prophylaxis shows no evidence of increased pneumonia. The American Journal of Surgery 176:5, 453-457
CrossRef221
(1998) Prevention of Gastrointestinal Bleeding during Mechanical Ventilation. New England Journal of Medicine 339:4, 266-268
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