Therapy: Clinical Scenario
A 55 year old male is admitted to the ICU from the operating room after having debridement of infected pancreatic necrosis. His past medical history is significant for alcohol consumption (6 beers per day) and a 50 pack year history of tobacco use. His postoperative orders include sucralfate. You explain that a recent clinical trial suggests that the risk of upper gastrointestinal bleeding is lower with the use of ranitidine. The surgeon states that he prefers sucralfate and would like to see the evidence. You formulate the question, "in mechanically ventilated patients who have undergone gastrointestinal surgery, do H2 blockers reduce the risk of upper gastrointestinal bleeding compared to the use of sucralfate?"
You search Best Evidence that you loaded on the computer in the ICU, using the terms 'Upper GI bleeding' and 'H2 blockers' and find the randomized clinical trial that assesses the risk of upper gastrointestinal bleeding in mechanically ventilated patients receiving sucralfate compared to ranitidine. The abstract appears to be exactly what you are looking for and the design is a randomized trial so you go to the library to pull the article (NEJM 1998;338:791-7). You read the article and see the surgeon on rounds the next morning and tell him you would like to discuss the evidence for your question.
Read the article and decide:
- Is the evidence from this randomized trial valid?
- If valid, is the evidence important?
- If valid and important, can you apply this evidence in caring for your patient?