Results of gastric neutralization with hourly antacids and cimetidine in 320 intubated patients with respiratory failure.

In a retrospective analysis massive upper gastrointestinal (GI) hemorrhage, defined as blood loss requiring more than two units of blood transfusion over a 24-hour period, occurred in 40 (9.5 percent) of 420 intubated, mechanically ventilated patients with respiratory failure, irrespective of the etiology of the respiratory failure. In a prospective study hourly antacid gastric neutralization, maintaining the gastric pH over 5, the incidence of massive gastric bleeding was reduced to 3 (1.4 percent) of 210 patients. In 110 additional patients, cimetidine, a histamine H2 receptor blocker, was used to prevent gastric acid secretion; 3 (2.7 percent) of 110 patients had massive upper GI bleeding; all three had solitary chronic pyloric ulcers. We conclude that gastric neutralization, either with hourly antacids or with cimetidine, is effective in reducing the incidence of massive gastric hemorrhage in intubated, mechanically ventilated patients during respiratory failure. We recommend the use of either in all intubated patients with respiratory failure. In addition, in 17 patients who had gastric bleeding at the time of transfer to the respiratory intensive care unit, gastric neutralization with hourly antacids in 14 patients and with cimetidine in three patients stopped the bleeding in all 17 patients within 24 to 48 hours.