Stress Ulcer Prophylaxis: The Prevention of Gastrointestinal Bleeding and the Development of Nosocomial Infections in Critically Ill Patients

Reilly, Joseph; Fennerty, M. Brian

doi:10.1177/089719009801100603

Cited by 13 publications

(9 citation statements)

References 66 publications

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“…10,11 When examined endoscopically, there is evidence of SRMD in 74% to 100% of patients within 24 hours of ICU admission. 21 However, clinically significant stress ulcerassociated bleeding (CSB) is much less common, occurring in about 1% to 4% of critically ill patients.…”

Section: Epidemiologymentioning

confidence: 98%

“…21 However, clinically significant stress ulcerassociated bleeding (CSB) is much less common, occurring in about 1% to 4% of critically ill patients. 10,[12][13][14][15] In a cohort of 2252 ICU patients, Cook and colleagues 1 found that 4.4% had an overt bleeding episode, and 1.5% had CSB. This was substantially reduced from reports in the decades before.…”

Section: Epidemiologymentioning

confidence: 99%

See 1 more Smart Citation

Is Prophylaxis for Stress Ulceration Useful?

Hayes¹,

Marsh²

2010

Evidence-Based Practice of Critical Care

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Section: Epidemiologymentioning

confidence: 98%

Section: Epidemiologymentioning

confidence: 99%

Is Prophylaxis for Stress Ulceration Useful?

Hayes¹,

Marsh²

2010

Evidence-Based Practice of Critical Care

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“…In fact, within 24 hours of admission to an ICU, many patients (75% to 100%) have endoscopic evidence of mucosal damage. 44 In the modern ICU, bleeding from stress-induced mucosal lesions continues to be a problem in critically ill patients, although its incidence has decreased dramatically over the past decade. In studies that range in size from less than 300 patients to greater than 1000, the frequency of bleeding varies from less than 1% to as high as 3%.…”

Section: Srmd Epidemiologymentioning

confidence: 99%

“…In 2 studies, H pylori seropositivity was similar in groups that bled when compared with those that did not bleed, and, in fact, in one of the studies, the rate was actually lower in the group that bled. 44 Risk Factors (Table 4) Because the prevalence of clinically important GI bleeds has been so low over the last decade, the population of patients that would benefit from prophylaxis is limited. It is therefore important to identify risk factors for the development of stress ulcers and to then treat those populations.…”

Section: Pathophysiologymentioning

confidence: 99%

Complications of Critical Illness

Patel¹,

Gurka²,

Elpern³

et al. 2005

Clinical Pulmonary Medicine

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Despite the diagnostic and therapeutic advances that have occurred in medical practice over the past 3 decades, critically ill patients all too frequently develop complications that can result in increased morbidity, mortality, and cost of care. Among the most commonly encountered complications are venous thromboembolic disease (VTE), ventilator-associated pneumonia (VAP), catheterassociated infections (CAI), and stress-related mucosal disease (SRMD). Fortunately, clinicians have effective prophylactic strategies to prevent these complications in high-risk critically ill patients. Essential aspects of management for the critically ill patient should include knowledge of the risk factors for development, skill in recognition, and awareness of prevention strategies for the common complications of critical illness. In practical terms, the major obstacle has been failure to implement effective prophylactic strategies early enough in the "at-risk population" to achieve the beneficial effects on outcome. The best educational plan appears to be targeting the medical students and house staff, along with the intensive care unit nurses, pharmacists, and respiratory therapists. It is hoped that through education and the development of management protocols, morbidity and mortality will be improved for the critically ill patient.(Clin Pulm Med 2005;12: 258 -268) T he past 3 decades have produced tremendous advances in our understanding of disease processes, technological support, and improved diagnostic and therapeutic techniques.These advances have resulted in additional challenges for the care of the acutely ill patient. The challenge of caring for the critically ill patient includes diagnosis and treatment of the acute derangement that resulted in the intensive care unit (ICU) admission, continued management of the preexisting comorbid conditions, and the prevention of complications that frequently occur in the setting of critical illness. Common complications that are seen in the critically ill patient include venous thromboembolism (VTE), nosocomial infectious complications (ventilator-associated pneumonia ͓VAP͔, catheter-related bloodstream infections, etc), stress-related mucosal disease (SRMD), malnutrition, translocation of intestinal bacteria and/or endotoxin, critical illness polymyopathy and polyneuropathy, and single-and multiple-organ dysfunction/failure. Recognition of these potential complications has resulted in an increased implementation of prophylactic strategies in an attempt to reduce the incidence and adverse outcomes associated with these complications. There has been increased recognition of the importance of following recommendations and guidelines based on sound evidence from well-conducted clinical trials to achieve improved outcome. It has become clear that successful strategies for the care of the critically ill patient must incorporate a focus on prevention of common complications, as well as continued emphasis on treatment directed toward the acute process which mandated intensive care treatmen...

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“…Recent studies have shown that the incidence of overt GI bleeding in ICU patients ranges from 4.4%−5.7%, whereas the incidence of clinically important hemorrhage is lower, ranging from 1%−4% 21 . According to Reilly and Fennerty, 22 “Clinically important hemorrhage is defined as overt bleeding plus hemodynamic changes, defined as the presence of hypotension, tachycardia, orthostasis, or need for blood transfusion.” Although of lower incidence, the mortality of patients with clinically important hemorrhage has been shown to be as high as 31%, making the prevention of GIBs highly important within the scope of managing critically ill patients 23 . In 2005, McClave and Chang 24 described 2 distinct scenarios for GIB in the ICU: (1) stress ulceration, which occurs in the critically ill patient who develops a GIB several days after admission to the ICU, and (2) the patient who is admitted with a primary severe upper GIB.…”

Section: Open Abdomenmentioning

confidence: 99%

Safety of Enteral Feeding in Patients With Open Abdomen, Upper Gastrointestinal Bleed, and Perforation Peritonitis

Guillaume

Seres

2012

Nut in Clin Prac

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Provision of enteral nutrition (EN) has historically been withheld after major abdominal operations until bowel activity returns. Evidence suggests that EN is safe in critically ill patients with a variety of illnesses, specifically after abdominal surgery. There is a strong association between poor nutrition status and worse outcomes in critically ill patients. The fear has been that EN, by virtue of increased luminal pressure or demand to the splanchnic circulation, may compromise the integrity of anastomotic repairs and place patients at risk for complications. In this review, the authors analyze the safety of EN in the setting of the open abdomen, upper gastrointestinal bleeding, and perforation peritonitis, with evidence from published clinical trials and meta-analyses.

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Stress Ulcer Prophylaxis: The Prevention of Gastrointestinal Bleeding and the Development of Nosocomial Infections in Critically Ill Patients

Cited by 13 publications

References 66 publications

Is Prophylaxis for Stress Ulceration Useful?

Is Prophylaxis for Stress Ulceration Useful?

Complications of Critical Illness

Safety of Enteral Feeding in Patients With Open Abdomen, Upper Gastrointestinal Bleed, and Perforation Peritonitis

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