Randomized prospective evaluation of cimetidine and antacid control of gastric pH in the critically ill
Joseph C. Stothert,David A. Simonowitz,E. P. Dellinger,Mary Farley,William H. Edwards,Andrew D. Blair,Ralph E. Cutler,C. Carrico +7 more
TLDR
Antacids ottered consistent protection against gastric acidity and were 100% effective and all patients were protected from significant stress bleeding while on this study.Abstract:
One hundred forty-four critically ill patients admitted to an intensive care setting were randomly assigned to cimetidine or antacid treatament groups. Gastric pH was monitored hourly. One hundred twenty-three (85%) patients demonstrated a fall in pH to less than 4 and were considered to require prophylaxis. Prophylaxis was considered adequate if the measured pH could then be maintained at greater than or equal to 4. Fifty-eight patients received antacids alone, the average requirement being 41 cc/hour. Sixty-five patients received cimetidine. Seventeen (26%) of the cimetidine prophylaxis patients failed to raise their pH and were than placed on hourly administration of antacid with successful elevations of pH to greater than or equal to 4 in all cases on an average supplementary dose of 53 cc/hour. Risk factors, including sepsis, hypotension, head injury, respiratory failure, degree of trauma, and age, were not statistically different in the two treated groups. Using these same criteria, responders to cimetidine could not be differentiated from nonresponders. All patients were protected from significant stress bleeding while on this study. Significant complications of either treatment were minimal. Antacids offered consistent protection against gastric acidity and were 100% effective. A routine schedule of 300 mg every six hours of cimetidine was effective in only 47% of patients, and the maximum dose of cimetidine was effective in only 74% of patients. Hourly measurement of intragastric pH is required for monitoring the response to prophylaxis of stress bleeding in severely ill patients.read more
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Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012.
R. P. Dellinger,Mitchell M. Levy,Andrew Rhodes,Djillali Annane,Herwig Gerlach,Steven M. Opal,Jonathan E. Sevransky,Charles L. Sprung,Ivor S. Douglas,Roman Jaeschke,Tiffany M. Osborn,Mark E. Nunnally,Konrad Reinhart,Ruth M. Kleinpell,Derek C. Angus,Clifford S. Deutschman,Flávia Ribeiro Machado,Gordon D. Rubenfeld,Steven A R Webb,Richard Beale,Jean Louis Vincent,Rui Moreno +21 more
TL;DR: An update to the “Surviving Sepsis Campaign Guidelines for Management of Severe Sepsis and Septic Shock,” last published in 2008 is provided.
Journal ArticleDOI
Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock, 2012
R. Phillip Dellinger,Mitchell M. Levy,Andrew Rhodes,Djillali Annane,Herwig Gerlach,Steven M. Opal,Jonathan E. Sevransky,Charles L. Sprung,Ivor S. Douglas,Roman Jaeschke,Tiffany M. Osborn,Mark E. Nunnally,Sean R. Townsend,Konrad Reinhart,Ruth M. Kleinpell,Derek C. Angus,Clifford S. Deutschman,Flávia Ribeiro Machado,Gordon D. Rubenfeld,Steven A R Webb,Richard Beale,Jean Louis Vincent,Rui Moreno +22 more
TL;DR: A consensus committee of 68 international experts representing 30 international organizations was convened in 2008 to provide an update to the "Surviving Sepsis Campaign Guidelines for Management of Severe Sepsis and Septic Shock".
Journal ArticleDOI
Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2008.
R. Phillip Dellinger,Mitchell M. Levy,J. Carlet,Julian Bion,Margaret M. Parker,Roman Jaeschke,Konrad Reinhart,Derek C. Angus,Christian Brun-Buisson,Richard Beale,Thierry Calandra,JF Dhainaut,Herwig Gerlach,Maurene A. Harvey,John J. Marini,John C. Marshall,Marco Ranieri,Graham Ramsay,Jonathan E. Sevransky,B. Taylor Thompson,Sean R. Townsend,Jeffrey S. Vender,Janice L. Zimmerman,Jean Louis Vincent +23 more
TL;DR: In this paper, the authors provide an update to the original Surviving Sepsis Campaign clinical management guidelines for management of severe sepsis and septic shock, published in 2004.
Surviving sepsis campaign: international guidelines for the management of severe sepsis and septic shock: 2008
TL;DR: To provide an update to the original Surviving Sepsis Campaign clinical management guidelines, the GRADE system was used to guide assessment of quality of evidence from high (A) to very low (D) and to determine the strength of recommendations.
Journal ArticleDOI
Surviving Sepsis Campaign guidelines for management of severe sepsis and septic shock
R. Phillip Dellinger,Jean 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 +13 more
TL;DR: Evidence-based recommendations can be made regarding many aspects of the acute management of sepsis and septic shock that will hopefully translate into improved outcomes for the critically ill patient.
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Journal ArticleDOI
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