Randomized Controlled Trial
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Apr 27, 2025; 17(4): 100806
Published online Apr 27, 2025. doi: 10.4240/wjgs.v17.i4.100806
Effectiveness of a multi-modal intervention protocol for preventing stress ulcers in critically ill older patients after gastrointestinal surgery
Hai-Ming Xi, Man-Li Tian, Ya-Li Tian, Hui Liu, Yun Wang, Min-Juan Chu
Hai-Ming Xi, Ya-Li Tian, Hui Liu, Yun Wang, Min-Juan Chu, Geriatric ICU, Jiangsu Province Hospital, Nanjing 210029, Jiangsu Province, China
Man-Li Tian, Department of Respiratory and Critical Care Medicine, Nanjing Central Hospital, Nanjing 210000, Jiangsu Province, China
Co-first authors: Hai-Ming Xi and Man-Li Tian.
Author contributions: Xi HM and Chu MJ jointly the concept of this study and participated in data collection; Xi HM drafted the initial; Tian ML, Tian YL, and Liu H contributed to the formal analysis of this study; Wang Y guided the research, methodology, and visualization of the manuscript; Xi HM, Tian ML, Tian YL, Liu H, Wang Y, and Chu MJ participated in this study, validated it, and jointly reviewed and edited the manuscript. Xi HM and Chu MJ contributed equally to this work as co-first authors.
Institutional review board statement: This study has been reviewed and approved by the medical ethics committee of Jiangsu People's Hospital, approval No. 2022-147.
Clinical trial registration statement: This study is registered at the Clinical Registry. https: //www.researchregistry.com (researchregistry10979).
Informed consent statement: Informed consent was obtained from all patients and their guardians, with signed consent forms.
Conflict-of-interest statement: The author declares no potential conflicts of interest.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
Data sharing statement: No additional data are available.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Min-Juan Chu, Geriatric ICU, Jiangsu Province Hospital, No. 300 Guangzhou Road, Nanjing 210029, Jiangsu Province, China. cmjzxcvbnm@yeah.net
Received: December 13, 2024
Revised: January 17, 2025
Accepted: February 11, 2025
Published online: April 27, 2025
Processing time: 105 Days and 21.2 Hours
Abstract
BACKGROUND

Stress ulcers are common complications in critically ill patients, with a higher incidence observed in older patients following gastrointestinal surgery. This study aimed to develop and evaluate the effectiveness of a multi-modal intervention protocol to prevent stress ulcers in this high-risk population.

AIM

To assess the impact of a multi-modal intervention on preventing stress ulcers in older intensive care unit (ICU) patients postoperatively.

METHODS

A randomized controlled trial involving critically ill patients (aged ≥ 65 years) admitted to the ICU after gastrointestinal surgery was conducted. Patients were randomly assigned to either the intervention group, which received a multi-modal stress ulcer prevention protocol, or the control group, which received standard care. The primary outcome measure was the incidence of stress ulcers. The secondary outcomes included ulcer healing time, complication rates, and length of hospital stay.

RESULTS

A total of 200 patients (100 in each group) were included in this study. The intervention group exhibited a significantly lower incidence of stress ulcers than the control group (15% vs 30%, P < 0.01). Additionally, the intervention group demonstrated shorter ulcer healing times (mean 5.2 vs 7.8 days, P < 0.05), lower complication rates (10% vs 22%, P < 0.05), and reduced length of hospital stay (mean 12.3 vs 15.7 days, P < 0.05).

CONCLUSION

This multi-modal intervention protocol significantly reduced the incidence of stress ulcers and improved clinical outcomes in critically ill older patients after gastrointestinal surgery. This comprehensive approach may provide a valuable strategy for managing high-risk populations in intensive care settings.

Keywords: Stress ulcers; Older patients; Gastrointestinal surgery; Critical care; Multi-modal intervention

Core Tip: This study evaluated a comprehensive multimodal intervention aimed at preventing stress ulcers in critically ill patients aged ≥ 65 years after undergoing gastrointestinal surgery. In a randomized controlled trial with 200 participants, the incidence of stress ulcers was significantly lower in those who participated in the intervention. These findings highlight the effectiveness of the multimodal approach and suggest that it may be a valuable strategy for improving clinical outcomes in vulnerable patient populations in intensive care settings.