(400) Analysis of Enteral Nutrition With and Without Chemical Stress Ulcer Prophylaxis in Intubated Adults

Introduction: The surviving sepsis guidelines recommend using proton pump inhibitors (PPI) or histamine 2 receptor antagonist (H2RA) for pharmacologic stress ulcer prophylaxis (SUP) in critically ill patients requiring invasive mechanical ventilation (IMV). A potential non-pharmacologic approach is enteral nutrition (EN). The purpose of this study was to determine if the incidence of major GI bleeding differed for patients receiving EN and SUP compared to EN alone.

Methods: This was a single-center, retrospective, cohort study from March 2020 to March 2021 at a level 1 trauma center and academic medical center with five adult intensive care units (ICU). Study included patients requiring IMV for at least 48 hours in the MICU and patients were screened based on pre-specified exclusion criteria. The primary objective was the incidence of major gastrointestinal (GI) bleeding in patients receiving EN with or without SUP. Secondary objectives included: 30-day all-cause mortality, ICU length of stay (LOS), duration of IMV, incidence of Clostridioides difficile infection (CDI), incidence of pneumonia, and discharge within 30 days of hospital admission.

Results: Of the 1,068 patients screened, 70 patients were included with 42 patients receiving EN alone and 28 patients receiving SUP plus EN. The primary outcome occurred in 7 patients, 3 patients (11%) in SUP plus EN and 4 patients (9.5%) in EN (p > 0.9). Statistical significant differences were found in ICU LOS, duration of IMV, and discharge within 30 days of hospital admission, all favoring SUP plus EN.

Conclusions: The addition of SUP had no effect on rates of major GI bleeding for patients requiring IMV. Secondary endpoints favored the addition of SUP. These results emphasize the need for prospective trials comparing the use of SUP in addition to EN compared to EN alone.