Stress ulcer prophylaxis
Bleeding from diffuse gastric erosions or ulceration is still an occasional life-threatening complication in seriously ill patients in the intensive care unit, though improved management of sepsis, circulatory collapse and hypoxaemia may have reduced the risk. Prophylaxis is generally advised for these patients. Patients most likely to benefit are:
- patients with burns to more than 30% of their body surface area
- seriously ill patients with clinically significant coagulopathy
- seriously ill patients who require mechanical ventilation for longer than 48 hours.
Also consider prophylaxis in patients who have had a peptic ulcer when it is not known whether the cause (Helicobacter pylori or nonsteroidal anti-inflammatory drugs) has been removed.
Clear evidence to guide the choice of drug (proton pump inhibitor [PPI] or H2-receptor antagonist), preferred route of administration (oral, nasogastric or intravenous) and duration of therapy for stress ulcer prophylaxis is lacking; local practice varies. Oral or nasogastric administration is preferred, mainly for cost reasons. If oral absorption is likely to be poor, intravenous administration is required.
PPI or H2-receptor antagonist therapy should be stopped if there is no ongoing indication and the patient is no longer acutely ill.