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Continuous intravenous cimetidine decreases stress-related upper gastrointestinal hemorrhage without promoting pneumonia.

dc.contributor.author Martin, LF
dc.contributor.author Booth, FV
dc.contributor.author Karlstadt, RG
dc.contributor.author Silverstein, JH
dc.contributor.author Jacobs, DM
dc.contributor.author Hampsey, J
dc.contributor.author Bowman, SC
dc.contributor.author D'Ambrosio, CA
dc.contributor.author Rockhold, FW
dc.coverage.spatial United States
dc.date.accessioned 2015-12-03T17:49:58Z
dc.date.issued 1993-01
dc.identifier https://www.ncbi.nlm.nih.gov/pubmed/8420726
dc.identifier.issn 0090-3493
dc.identifier.uri https://hdl.handle.net/10161/11028
dc.description.abstract OBJECTIVES: To determine whether a continuous i.v. infusion of cimetidine, a histamine-2 (H2) receptor antagonist, is needed to prevent upper gastrointestinal (GI) hemorrhage when compared with placebo and if that usage is associated with an increased risk of nosocomial pneumonia. Due to the importance of this latter issue, data were collected to examine the occurrence rate of nosocomial pneumonia under the conditions of this study. DESIGN: A multicenter, double-blind, placebo-controlled study. INTERVENTIONS: Patients were randomized to receive cimetidine (n = 65) as an iv infusion of 50 to 100 mg/hr or placebo (n = 66). SETTING: Intensive care units in 20 institutions. PATIENTS: Critically ill patients (n = 131), all of whom had at least one acute stress condition that previously had been associated with the development of upper GI hemorrhage. MEASUREMENTS AND MAIN RESULTS: Samples of gastric fluid from nasogastric aspirates were collected every 2 hrs for measurement of pH and were examined for the presence of blood. Upper GI hemorrhage was defined as bright red blood or persistent (continuing for > 8 hrs) "coffee ground material" in the nasogastric aspirate. Baseline chest radiographs were performed and sputum specimens were collected from all patients, and those patients without clear signs of pneumonia (positive chest radiograph, positive cough, fever) at baseline were followed prospectively for the development of pneumonia while receiving the study medication. Cimetidine-infused patients experienced significantly (p = .009) less upper GI hemorrhage than placebo-infused patients: nine (14%) of 65 cimetidine vs. 22 (33%) of 66 placebo patients. Cimetidine patients demonstrated significantly (p = .0001) higher mean intragastric pH (5.7 vs. 3.9), and had intragastric pH values at > 4.0 for a significantly (p = .0001) higher mean percentage of time (82% vs. 41%) than placebo patients. Differences in pH variables were not found between patients who had upper GI hemorrhage and those patients who did not, although there was no patient in the cimetidine group who bled with a pH < 3.5 compared with 11 such patients in the placebo group. Also, the upper GI hemorrhage rate in patients with one risk factor (23%) was similar to that rate in patients with two or more risk factors (25%). Of the 56 cimetidine-infused patients and 61 placebo-infused patients who did not have pneumonia at baseline, no cimetidine-infused patient developed pneumonia while four (7%) placebo-infused patients developed pneumonia. CONCLUSIONS: The continuous i.v. infusion of cimetidine was highly effective in controlling intragastric pH and in preventing stress-related upper GI hemorrhage in critically ill patients without increasing their risk of developing nosocomial pneumonia. While the number of risk factors and intragastric pH may have pathogenic importance in the development of upper GI hemorrhage, neither the risk factors nor the intragastric pH was predictive. Therefore, short-term administration of continuously infused cimetidine offers benefits in patients who have sustained major surgery, trauma, burns, hypotension, sepsis, or single organ failure.
dc.language eng
dc.publisher Ovid Technologies (Wolters Kluwer Health)
dc.relation.ispartof Crit Care Med
dc.subject Adolescent
dc.subject Adult
dc.subject Aged
dc.subject Aged, 80 and over
dc.subject Cimetidine
dc.subject Critical Care
dc.subject Cross Infection
dc.subject Double-Blind Method
dc.subject Female
dc.subject Gastric Acidity Determination
dc.subject Gastric Juice
dc.subject Humans
dc.subject Infusions, Intravenous
dc.subject Intensive Care Units
dc.subject Male
dc.subject Middle Aged
dc.subject Peptic Ulcer
dc.subject Peptic Ulcer Hemorrhage
dc.subject Pneumonia
dc.subject Risk Factors
dc.subject Severity of Illness Index
dc.subject Stress, Physiological
dc.title Continuous intravenous cimetidine decreases stress-related upper gastrointestinal hemorrhage without promoting pneumonia.
dc.type Journal article
duke.contributor.id Rockhold, FW|0668002
pubs.author-url https://www.ncbi.nlm.nih.gov/pubmed/8420726
pubs.begin-page 19
pubs.end-page 30
pubs.issue 1
pubs.organisational-group Basic Science Departments
pubs.organisational-group Biostatistics & Bioinformatics
pubs.organisational-group Duke
pubs.organisational-group Duke Clinical Research Institute
pubs.organisational-group Institutes and Centers
pubs.organisational-group School of Medicine
pubs.publication-status Published
pubs.volume 21
duke.contributor.orcid Rockhold, FW|0000-0003-3732-4765


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