Copyright
©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Crit Care Med. Feb 4, 2016; 5(1): 57-64
Published online Feb 4, 2016. doi: 10.5492/wjccm.v5.i1.57
Published online Feb 4, 2016. doi: 10.5492/wjccm.v5.i1.57
Prevention of stress-related ulcer bleeding at the intensive care unit: Risks and benefits of stress ulcer prophylaxis
Lukas Buendgens, Alexander Koch, Frank Tacke, Department of Medicine III, University Hospital Aachen, 52074 Aachen, Germany
Author contributions: Buendgens L, Koch A and Tacke F wrote this review.
Supported by The German Research Foundation, No. DFG Ta434/5-1; and the Interdisciplinary Center for Clinical Research (IZKF) Aachen.
Conflict-of-interest statement: The authors declare no conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Frank Tacke, MD, PhD, Department of Medicine III, University Hospital Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany. frank.tacke@gmx.net
Telephone: +49-241-8035848 Fax: +49-241-8082455
Received: October 4, 2015
Peer-review started: October 9, 2015
First decision: November 4, 2015
Revised: November 13, 2015
Accepted: January 5, 2016
Article in press: January 7, 2016
Published online: February 4, 2016
Processing time: 111 Days and 21.4 Hours
Peer-review started: October 9, 2015
First decision: November 4, 2015
Revised: November 13, 2015
Accepted: January 5, 2016
Article in press: January 7, 2016
Published online: February 4, 2016
Processing time: 111 Days and 21.4 Hours
Core Tip
Core tip: To prevent gastrointestinal (GI) bleeding due to stress-related mucosal disease, critically ill patients are often routinely treated with proton pump inhibitors (PPI) or histamine 2 receptor antagonists (H2RA) for stress ulcer prophylaxis (SUP) in the intensive care unit (ICU). While major GI bleeding is currently rare in the ICU, SUP has not improved the overall survival of ICU patients in large clinical trials. Moreover, PPI and H2RA pose significant risks including toxicity, drug-drug-interactions and infectious complications (e.g., nosocomial pneumonia or Clostridium difficile-associated diarrhea). Instead of routine SUP, risk-adjusted algorithms may better balance benefits and threats of SUP in the ICU.