Gastrointestinal Prophylaxis in Neurocritical Care
Abstract The aim of this study is to review and summarize the relevant literature regarding pharmacologic and non-pharmacologic methods of prophylaxis against gastrointestinal (GI) stress ulceration, and upper gastrointestinal bleeding in critically ill patients. Stress ulcers are a known complication of a variety of critical illnesses. The literature regarding epidemiology and management of stress ulcers and complications thereof, is vast and mostly encompasses patients in medical and surgical intensive care units. This article aims to extrapolate meaningful data for use with a population of critically ill neurologic and neurosurgical patients in the neurological intensive care unit setting. Studies were identified from the cochrane central register of controlled trials and NLM PUBMED for english articles dealing with an adult population. We also scanned bibliographies of relevant studies. The results show that H2A, sucralfate, and PPI all reduce the incidence of UGIB in neurocritically ill patients, but H2A blockers may cause encephalopathy and interact with anticonvulsant drugs, and have been associated with higher rates of nosocomial pneumonias, but causation remains unproven and controversial. For these reasons, we advocate against routine use of H2A for GI prophylaxis in neurocritical patients. There is a paucity of high-level evidence studies that apply to the neurocritical care population. From this study, it is concluded that stress ulcer prophylaxis among critically ill neurologic and neurosurgical patients is important in preventing ulcer-related GI hemorrhage that contributes to both morbidity and mortality. Further, prospective trials are needed to elucidate which methods of prophylaxis are most appropriate and efficacious for specific illnesses in this population.
- Content Type Journal Article
- Pages 1-10
- DOI 10.1007/s12028-011-9580-1
- Authors
- Clemens M. Schirmer, Department of Neurological Surgery, Tufts University School of Medicine, Boston, MA 02111, USA
- Joshua Kornbluth, Department of Neurology, Tufts University School of Medicine, Boston, MA 02111, USA
- Carl B. Heilman, Department of Neurological Surgery, Tufts University School of Medicine, Boston, MA 02111, USA
- Anish Bhardwaj, Department of Neurological Surgery, Tufts University School of Medicine, Boston, MA 02111, USA
- Journal Neurocritical Care
- Online ISSN 1556-0961
- Print ISSN 1541-6933
