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[Prophylaxis of gastroduodenal hemorrhage caused by stress during pediatric intensive care]
J Lacroix1, M Gauthier, C A Farrell
1Soins intensifs pédiatriques, département de pédiatrie, hôpital Sainte-Justine, université de Montréal, Québec, Canada.
Insights
Intensive care patients often face stress ulcers and upper gastrointestinal bleeding (UGIB). Prophylactic medications may not prevent severe UGIB, suggesting a selective approach for high-risk patients is more appropriate.
Area of Science:
- Gastroenterology
- Critical Care Medicine
Context:
- Patients in intensive care units (ICUs) are susceptible to stress ulcers and erosive gastritis.
- Stress-related upper gastrointestinal bleeding (UGIB) is a significant concern in ICUs.
Purpose:
- To review the literature on the efficacy of prophylactic agents for stress-related UGIB in ICU patients.
- To evaluate whether current prophylactic strategies reduce clinically significant UGIB and its associated complications.
Summary:
- Prophylactic use of antacids, H2 receptor antagonists, or sucralfate is common in ICUs to prevent UGIB.
- Evidence suggests these agents decrease overall UGIB incidence but not necessarily clinically significant bleeding (anemia, shock, death).
- The cost and potential complications of routine prophylaxis warrant a re-evaluation of its systematic use.
Impact:
- Proposes a conservative and selective approach to prophylaxis, targeting only patients at highest risk for UGIB.
- Highlights the need to consider the balance between benefits, costs, and complications of prophylactic therapies in critically ill patients.
Abstract:
Patients admitted to intensive care units frequently develop stress ulcers, erosive gastritis and complications such as upper gastrointestinal bleeding. Stress-related upper gastrointestinal bleeding (UGIB) has been of particular concern to many practitioners working in intensive care units and has led to the treatment of most if not all patients admitted to these units with antacids, H2 receptor antagonists or sucralfate in order to protect the gastric mucosa. It is considered that the 3 aforementioned medications are effective in decreasing the overall incidence of UGIB, but it has not been demonstrated that they are efficacious in reducing the incidence of clinically significant UGIB, ie cases that are complicated by anemia, hemorrhagic shock, or death. In addition, the cost and complications resulting from prophylaxis should be taken into consideration, which raises further questions about the systematic use of these agents. This article reviews the current literature on this subject; the authors propose a conservative use of prophylaxis, and that these agents be prescribed in a selective manner to the patients at the greatest risk of developing UGIB.