Stress ulcers in intensive care (etiology, symptomatology and therapy)

Mircea, N; Jianu, E; Constantinescu, Corneliu; Constantinescu, Nicolae; Daşchievici, S; Buşu, G; Nedelcu, Adrian; Leoveanu, A

doi:10.1016/0300-9572(84)90060-1

Cited by 5 publications

(6 citation statements)

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“…Sepsis has been noted in 50 to 74% and shock in 15 to 71 % of patients with overt bleeding from stress ulcers in the settings of trauma [9,58] and surgery [19,26]. The presence of shock correlated significantly with overt bleeding in trauma patients [58].…”

Section: Risk Factorsmentioning

confidence: 94%

“…Surgical therapy has been required in 10 to 60% of patients; mortality in patients who bleed from stress ulcer is 50 to 77% [9,10,[16][17][18]20,[24][25][26]28]. This is in contrast to the 9 to 22% mortality rate among ICU patients without bleeding [18,24].…”

Section: Clinical Presentation and Coursementioning

confidence: 97%

“…Sepsis has been implicated as a risk factor in a variety of settings including burn patients [17], postoperative patients [26], trauma patients [9], and other medical and surgical ICU patients [28,32,54]. Sepsis alone may be an independent risk factor for stress bleeding [58,68].…”

Section: Risk Factorsmentioning

confidence: 99%

“…A randomized trial from a surgical ICU noted that up to 13% of untreated patients have evidence of overt UGI bleeding [57]. Patients recovering from abdominal, cardiovascular, and thoracic surgery seem to be at highest risk [10,26]. Intraabdominal, thoracoabdominal, and spinal injuries are more frequently associated with stress bleeding compared with patients with isolated chest or soft-tissue injury [9,58].…”

Section: Risk Factorsmentioning

confidence: 99%

“…Stress ulcer usually clinically presents with UGI bleeding [17,20,23] (Table 1), occurring within 2 weeks of the precipitating insult [4,12,18,19,22,[24][25][26][27]. Hematemesis and melena are the common manifestations [6,9,17,21]; up to 10% of patients have massive hemorrhage [21,28].…”

Section: Clinical Presentation and Coursementioning

confidence: 99%

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Stress Ulcer Syndrome

Zuckerman

Cort

Shuman

1988

J Intensive Care Med

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MO 63110.Stress ulcer syndrome refers to gastroduodenal erosions or ulcers that develop acutely in relation to major physiological stress, usually manifested clinically as upper gastrointestinal (UGI) bleeding. These lesions occur most often in the gastric fundus. Endoscopy has shown gastroduodenal mucosal lesions in 75 to 100% of intensive care unit (ICU) patients within 72 hours of admission. Patients at high risk for stress ulcer include those with large body surface area burns, intracranial lesions associated with coma, fulminant hepatic failure, sepsis, and trauma and abdominal, cardiovascular, and thoracic surgery patients. Also considered high risk are ICU patients with superimposed complications such as shock, mechanical ventilation for more than 3 days, coagulopathy, jaundice, and sepsis. Approximately 15% of ICU patients will experience UGI bleeding from stress ulcer. Patients bleeding from stress ulcer have an overall mortality rate approaching 65% compared with 9 to 22% mortality in patients without stress ulcer. When stratified according to occult blood loss versus clinically significant bleeding, mortality can be as high as 90% in patients overtly bleeding; 30% of deaths are directly related to bleeding. Both antacids and H 2 receptor antagonists are effective in prophylaxis for stress ulcer bleeding.Gastrointestinal bleeding is a major problem in intensive care medicine, and upper gastrointestinal (UGI) hemorrhage may occur in 10% or more of intensive care unit (ICU) patients [1]. Bleeding representing the usual spectrum of UGI mucosal lesions can be responsible for admission to the ICU, but bleeding can also be a secondary complication that occurs during the ICU stay. The latter has been referred to as the clinical syndrome of &dquo;stress ulcer.&dquo; Stress ulcers are acutely formed defects in the gastroduodenal mucosa that develop in a critically ill patient with a severe physiological derangement.

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