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Stress Ulcers and GI Prophylaxis

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Stress Ulcers Loss of protective barrier in the stomach of the critically ill allows acid to damage walls. Respiratory failure and coagulopathy are major risk factors, other risk factors were sepsis, liver failure, hypotension and renal failure. (Nelligan)   The objective is to increase the gastric pH to >3.5 Ranitidine and Sucralfate are both effective. One MA showed no difference between the two (Messori A, Trippoli S, Vaiani M, Gorini M, Corrado A. Bleeding and pneumonia in intensive care patients given ranitidine and sucralfate for prevention of stress ulcer: meta-analysis of randomised controlled trials. BMJ 2000; 321(7269):1103-1106)   Downside is increased rate of VAP.   Prophylaxis is not just to

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prevent GI bleeds but to prevent erosions which become a portal of entry for bowel bacteria into the blood stream   Most recent Meta-Analysis (doi:10.1007/s00134-013-3125-3) shows no effect on anything (mortality, vap, gi bleed)

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