First Things First (assess & treat for the following)

• Superficial lesions in the gastric mucosal layer secondary to major stressful events
• Similar to NSAID-induced ulcerations but usually involve multiple sites
• Multifactorial pathogenesis
  • Acid hypersecretion
  • Decreased mucus production
  • Decreased epithelial turnover
  • Reduction in blood flow
• Major risk factors for development of stress ulcers include:
  • Respiratory failure requiring mechanical ventilation >48 hr
  • Coagulopathy
    • Platelets <50,000/mm3, INR >1.5 or aPTT >2 times control
    • Includes medication-induced (heparin, warfarin, etc.)
• Minor risk factors for development of stress ulcers include:
  • Sepsis
  • Trauma
  • Acute organ failure
    • Renal insufficiency
    • Hepatic failure
  • Thermal injury
  • Lack of enteral feeding
  • Prolonged ICU admission