Stress Ulcer Prophylaxis

Stress Ulcer Prophylaxis is a topic covered in the Pocket ICU Management.

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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

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Last updated: May 5, 2010