Stress ulcer prophylaxis in the critically ill patients

Abstract

tress-related mucosal disease (SRMD) was a significant cause of both morbidity and mortality in critically ill patients. Early active treatment reduces the risk of clinically important bleeding, stress ulcer prophylaxis therefore became a standard of care in all critically ill patients. Multiple gastric ulcerations were detected in trauma patients,in sever hemorrhage, shock, sepsis and patients with respiratory failure needing mechanical ventilation in ICU. Stress ulceration is a common complication in critically ill patients occurring through splanchnic hypoperfusion, mucosal ischemia, reperfusion injury, and mucosal exposure to intraluminal toxins following the disruption of the gastric mucosal defense system. Stress ulcer prophylaxis in risky critically ill patients is recommended to reduce the incidence of clinically important GI bleeding. Therefore, SUP with an H2RA, PPI, sucralfate, or combination therapy is advisable in critically ill patients. Cimetidine was the first H2RAs and has a well-established safety profile and limited data in patients would suggest cimetidine as the preferential H2RA medication, based on acid suppression profiles in trials.