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Ever experienced a tingling effect in your stomach when you climb over a ladder or irritation in your gut after a stubborn argument? This is because our brain has a “MIGHTY BOND” with our stomach. We’re aware of the fact that the brain possesses the highest number of nerve connections, so is the stomach. When trouble struck both interact with each other. Patients in ICU bear a lot of stress due to their clinical conditions and the treatment procedures. Hence GI problems are accustomed. In this article let’s have a hasty look over GI prophylaxis in adults.

Principally we cannot consider patients who are under active treatment of GI disorders for GI prophylaxis. These include patients suffering from conditions like:

# Gastric ulcers, GI bleeding, Hypersecretory disorders

# Gastrectomy

# GI bleeding due to NSAIDS, Anticoagulants, Antiplatelet agents and Steroids

# Solid organ transplant recipients

# Stress ulcer prophylaxis outside of the ICU

GI prophylaxis is given to patients having stress induced ulcers and GI bleeding.

CAUSES OF STRESS ULCERS:

# Gastric hypoperfusion

# Acid over secretion

# Under production of gastric mucous

# Helicobacter pylori infection

GI prophylaxis for stress induced ulcers is not mandatory for all patients in ICU.

RECOMMENDED INDICATION FOR STRESS ULCER PROPHYLAXIS (SUP) IN ICU:

ADULTS:

· Mechanical ventilation longing > 48 hours

· Coagulopathy not during exogenous anticoagulation

· platelets count < 50,000/μL

· INR > 1.5

· PTT > 2 times the control value

· Acute traumatic brain injury with Glasgow coma score ≤10 or inability to obey simple commands

· Acute spinal cord injury

· Major thermal injury (≥20% of total body surface area)

INDICATIONS WHEN SUP CAN BE CONSIDERED:

· History of GI ulceration or bleeding within 12 months before admission

· Partial hepatectomy in the ICU

INNAPROPRIATE INDICATIONS FOR SUP:

· Continuation of SUP beyond when indications no longer exist2,9

· Therapeutic anticoagulant therapy without additional risk factors9

· Short-term high dose corticosteroid therapy without additional risk factors33

· During the temporary period when patients are NPO after surgery or procedures with no additional risk factors

AGENTS FOR SUP:

· PPI

· H2RA

SUP DOSAGE FOR ADULTS:

Parenteral Dose

Pantoprazole 40 mg IV OD

Famotidine 20 mg IV Q12H

Sucralfate N/A

Enteral Dose

Pantoprazole 40 mg PO/NG OD

Famotidine 20 mg PO/NG BD

Sucralfate 1g PO/NG QID

(to be continued...)

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CHEARS

2021 - Team : 621| Registered : 1931

Dr. Shwetha Swaminath

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