Transcript GI Prophylaxis - UCI Department of Emergency Medicine

GI Prophylaxis
Godwin Tse LA TRAP 2011
What is it for?

Stress ulcer – gastrointestinal mucosal
injury related to critical illness  GI
bleeding
Pathophysiology[1]
Risk Factors[2][3]
 Coagulopathy
 Platelet count <50000mm3
 INR>1.5
 PTT>2x normal
 Mechanical ventilation > 48 hrs
Prophylaxis[4]
Antacids
 Sucralfate
 Histamine2 receptor antagonists
 Proton pump inhibitors
 Enteral feeding

Complications[5]

Nosocomial
Pneumonia
 Due to elevation of
gastric pH
 Certain meds may
increase risk of VAP
Fun Fact[6]
References

[1] Neligan, Patrick. Stress Ulceration in Critical Care. 2006. University of
Pennsylvania. Nov 30. 2011
<http://www.ccmtutorials.com/support/ulcers/page_03.htm>

[2] Cook DJ, Fuller HD, Guyatt GH et al. Risk factors for gastrointestinal bleeding
in critically ill patients. Canadian Critical Care Trials Group. N Engl J Med 1994;
330(6):377-381.

[3] Mutlu GM, Mutlu EA, Factor P. GI complications in patients receiving
mechanical ventilation. American College of Chest Physicians. Chest 2001;
119(4):1222-1241.

[4]Mohebbi L, Hesch K. Stress ulcer prophylaxis in the ICU. Baylor University
Medical Center Procedings. Baylor University Medical Proceedings 2009;
22(4):373-376.

[5]Miano TA, Reichert MG, Houle TT et al. Nosocomial Pneumonia Risk and
Stress Ulcer Prophylaxis. American College of Chest Physicians. Chest 2009;
136:440-447.

[6] Chemistry Blog. 2010. Nov 30 2011. <http://www.chemistry-blog.com/>