As the length of stay for many of our critically ill patients continues to rise, it is important to think about some preventative therapies
SRMI is the term used to describe gastric mucosal erosions that occur in the critically ill
SRMI can be demonstrated in 75 - 100% of critically ill patients within 24 hours and can cause clinically apparent bleeding in up to 25%
Independent risk factors for SRMI include mechanical ventilation, coagulopathy, and a prior history of gastritis or peptic ulcer disease
Additional risk factors in our ED patient population include sepsis, hypotensive states, severe head injury, multisystem trauma, and renal failure
Typically an H2 antagonist is provided (i.e. ranitidine or famotidine). Currently there is no evidence of superiority of PPIs over H2 antagonists in preventing SRMI
Pearl: the best agent to give is probably sucralfate - there is a slightly higher incidence of bleeding compared to ranitidine; however, ranitidine is associated with a much higher incidence of nosocomial pneumonia. The risk and mortality associated with nosocomial pneumonia in these patients outweighs the minimal risk of major hemorrhage associated with SRMI
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