Gastrointestinal prophylaxis in neurocritical care

Area of Science:

• Critical Care Medicine
• Gastroenterology
• Neuroscience

Background:

• Gastrointestinal (GI) stress ulceration and bleeding are common complications in critically ill patients.
• Existing literature primarily focuses on medical and surgical intensive care units, with limited data for neurological intensive care units.

Purpose of the Study:

• To review and summarize pharmacologic and non-pharmacologic prophylaxis methods for GI stress ulceration and bleeding.
• To extrapolate relevant data for critically ill neurologic and neurosurgical patients.

Main Methods:

• Literature search of Cochrane Central Register of Controlled Trials and NLM PubMed for adult English articles.
• Bibliography scanning of relevant studies.

Main Results:

• H2A blockers, sucralfate, and proton pump inhibitors (PPIs) reduce upper GI bleeding (UGIB) in neurocritically ill patients.
• H2A blockers may cause encephalopathy, interact with anticonvulsants, and are controversially linked to increased nosocomial pneumonias.

Conclusions:

• Routine use of H2A blockers for GI prophylaxis in neurocritical patients is not advocated.
• Stress ulcer prophylaxis is vital for preventing GI hemorrhage, morbidity, and mortality in this population.
• Further prospective trials are needed to determine optimal prophylaxis strategies for neurocritical care patients.