Preventive measures for stress ulcers in burn patients.
Between January 1981 and December 1985 336 patients with deep partial and full skin thickness burn injuries covering more than 20 per cent of the body surface area (BSA) were treated in our burn unit. During the first 3.5 years prophylactic therapy for stress ulcers consisted of cimetidine or ranitidine whereas during the last 18 months a combination of ranitidine and sucralfate was used. Over the whole period a protein-rich enteral feeding was instituted as early as possible after injury. Six times 200 mg/day cimetidine were administered intravenously during the first 4-6 days after injury, followed by a reduction to 4 x 200 mg/day usually until the end of the third week. Subsequently cimetidine was given orally in doses of 5 x 200 mg/day. Ranitidine (3 x 112 mg) was given intravenously until enteral feeding started, usually for the first 4 days, after oral nutrition had started the dosage was reduced to 3 x 56 mg/day. Over the past 18 months 4 x 1 g/day granular powdered sucralfate in combination with 3 x 56 mg/day ranitidine were given. The incidence of gastrointestinal bleeding was 2.5 per cent and no patient required surgical therapy. With respect to prophylaxis of bleeding and perforation of stress ulcers the triple regimen using sucralfate, ranitidine in low dosages and protein-rich enteral feeding appeared to be as effective as the earlier use of cimetidine or ranitidine. Side-effects of H2-blockade treatment, especially the high incidence of pneumonias caused by ascending infection from the gastrointestinal tract, were not seen. The high incidence of diarrhoea during H2-blockade treatment in combination with high protein enteral feeding remains to be solved.
Rath
T
T
Department of Plastic and Reconstructive Surgery, Ludwig Boltzmann Institute of Experimental Plastic Surgery, Vienna, Austria.
Walzer
L R
LR
Meissl
G
G
D002056:Burns / Q000150:complications*; D003131:Combined Modality Therapy; D004750:Enteral Nutrition; D005260:Female; D006635:Histamine H2 Antagonists / Q000627:therapeutic use; D006801:Humans; D008297:Male; D010437:Peptic Ulcer / Q000209:etiology / Q000517:prevention & control*; D011899:Ranitidine / Q000627:therapeutic use; D013315:Stress, Psychological / Q000150:complications*; D013392:Sucralfate / Q000627:therapeutic use
D006635:Histamine H2 Antagonists; D013392:Sucralfate; D011899:Ranitidine