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

LEEDING FROM THE upper gastrointestinal B tract due to stress related mucosal damage (SRMD) is a common and serious complication of critical illness that is associated with an increased morbidity and mortality. In the intensive care unit (ICU), SRMD is endemic, where endoscopic evidence of gastric erosions can be seen in 75% to 100% of critically ill patients within 72 hours of a major physical trauma or serious medical illness.' Peura and .Johnson2 showed that patients admitted to a medical ICU had endoscopic evidence of SRMD within 18 hours of admission. Although stress ulceration may be demonstrated endoscopically in most ICU patients, clinical signs or symptoms of bleeding may not be evident. Stress ulcerations can result in occult, overt, or clinically significant gastrointestinal bleeding. Occult bleeding is simply the detection of blood and is usually inconsequential. Patients with occult bleeding typically have a positive guaiac test of either stool or nasogastric aspi-